- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,185.54 / $5,005.84 / $10,691.75
| Facility | | $3,185.54 | $5,005.84 | $10,691.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,866.02 / $3,650.00 / $3,873.00
| Professional | | $2,866.02 | $3,650.00 | $3,873.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.73 / $4,809.88 / $15,104.70
| Facility | | $1,258.73 | $4,809.88 | $15,104.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.20 / $687.84 / $3,873.00
| Professional | | $573.20 | $687.84 | $3,873.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,456.46 / $6,495.02 / $11,618.03
| Facility | | $3,456.46 | $6,495.02 | $11,618.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.44 / $4,094.74 / $6,537.17
| Professional | | $2,062.44 | $4,094.74 | $6,537.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.15 / $2,130.15 / $3,873.00
| Facility | | $2,130.15 | $2,130.15 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $4,453.95
| Professional | | $1,626.66 | $2,323.80 | $4,453.95 |