- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,133.34 / $3,780.50 / $7,879.32
| Facility | | $2,133.34 | $3,780.50 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,078.51 / $2,379.67 / $3,943.62
| Professional | | $2,078.51 | $2,379.67 | $3,943.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $16,401.00 / $29,866.68
| Facility | | $8,512.20 | $16,401.00 | $29,866.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,182.21 / $2,961.59 / $4,707.89
| Professional | | $2,182.21 | $2,961.59 | $4,707.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,000.00 / $2,692.04
| Facility | | $900.00 | $1,000.00 | $2,692.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,338.31 / $3,294.69 / $5,199.70
| Professional | | $2,338.31 | $3,294.69 | $5,199.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,269.00 / $7,448.00
| Facility | | $1,185.00 | $3,269.00 | $7,448.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,082.60 / $3,035.56 / $5,160.08
| Professional | | $2,082.60 | $3,035.56 | $5,160.08 |