- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,508.35 / $2,076.28 / $6,389.94
| Facility | | $1,508.35 | $2,076.28 | $6,389.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,508.35 / $1,770.67 / $6,266.39
| Professional | | $1,508.35 | $1,770.67 | $6,266.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,725.64 / $13,190.30 / $19,227.78
| Facility | | $7,725.64 | $13,190.30 | $19,227.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.67 / $2,635.87 / $2,763.05
| Professional | | $2,290.67 | $2,635.87 | $2,763.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,562.00 / $24,606.00 / $30,556.00
| Facility | | $23,562.00 | $24,606.00 | $30,556.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,821.49 / $2,821.49 / $2,821.49
| Professional | | $2,821.49 | $2,821.49 | $2,821.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.62 / $2,687.56 / $4,893.84
| Professional | | $186.62 | $2,687.56 | $4,893.84 |