- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,222.41 / $4,430.50 / $9,248.34
| Facility | | $2,222.41 | $4,430.50 | $9,248.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,223.28 / $2,569.87 / $3,842.10
| Professional | | $2,223.28 | $2,569.87 | $3,842.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,279.00 / $8,800.00
| Facility | | $2,740.00 | $4,279.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,351.08 / $3,028.01 / $4,619.43
| Professional | | $2,351.08 | $3,028.01 | $4,619.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,261.97 / $2,307.72 / $2,486.93
| Facility | | $2,261.97 | $2,307.72 | $2,486.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,372.19 / $3,346.21 / $5,400.31
| Professional | | $2,372.19 | $3,346.21 | $5,400.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.00 / $2,710.00 / $5,483.50
| Facility | | $1,272.00 | $2,710.00 | $5,483.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,279.21 / $3,033.28 / $5,331.51
| Professional | | $2,279.21 | $3,033.28 | $5,331.51 |