- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.86 / $4,168.00 / $8,074.63
| Facility | | $2,248.86 | $4,168.00 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,175.21 / $2,638.52 / $3,877.14
| Professional | | $2,175.21 | $2,638.52 | $3,877.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $9,992.00 / $17,206.00
| Facility | | $4,989.00 | $9,992.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,196.16 / $2,795.56 / $4,531.63
| Professional | | $2,196.16 | $2,795.56 | $4,531.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,641.07 / $2,641.07 / $3,624.87
| Facility | | $2,641.07 | $2,641.07 | $3,624.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,257.92 / $3,459.00 / $5,681.96
| Professional | | $2,257.92 | $3,459.00 | $5,681.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,203.15 / $3,127.82 / $5,378.17
| Professional | | $2,203.15 | $3,127.82 | $5,378.17 |