- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,410.39 / $4,521.09 / $9,450.50
| Facility | | $1,410.39 | $4,521.09 | $9,450.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.16 / $1,280.31 / $2,024.80
| Professional | | $1,142.16 | $1,280.31 | $2,024.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,264.00 / $12,274.00
| Facility | | $3,877.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.94 / $1,542.10 / $2,489.54
| Professional | | $1,191.94 | $1,542.10 | $2,489.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.92 / $3,698.56 / $4,048.71
| Facility | | $3,072.92 | $3,698.56 | $4,048.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.44 / $1,816.16 / $3,034.71
| Professional | | $1,252.44 | $1,816.16 | $3,034.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.83 / $1,638.61 / $2,790.70
| Professional | | $1,200.83 | $1,638.61 | $2,790.70 |