- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,007.18 / $5,838.51 / $39,984.00
| Facility | | $2,007.18 | $5,838.51 | $39,984.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.18 / $2,007.18 / $8,296.00
| Professional | | $2,007.18 | $2,007.18 | $8,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.81 / $2,287.86 / $2,531.61
| Facility | | $1,949.81 | $2,287.86 | $2,531.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $1,730.32
| Professional | | $1,730.32 | $1,730.32 | $1,730.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,443.94 / $3,381.34 / $4,854.39
| Facility | | $2,443.94 | $3,381.34 | $4,854.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $1,926.21
| Professional | | $1,730.32 | $1,730.32 | $1,926.21 |