- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.89 / $4,088.16 / $8,074.63
| Facility | | $2,010.89 | $4,088.16 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,833.38 / $2,217.19 / $3,078.12
| Professional | | $1,833.38 | $2,217.19 | $3,078.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,400.00
| Facility | | $5,470.00 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,848.76 / $2,505.00 / $3,967.14
| Professional | | $1,848.76 | $2,505.00 | $3,967.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.71 / $2,132.71 / $5,079.35
| Facility | | $2,132.71 | $2,132.71 | $5,079.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,078.53 / $2,828.05 / $4,485.96
| Professional | | $2,078.53 | $2,828.05 | $4,485.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,906.23 / $2,711.54 / $4,698.58
| Professional | | $1,906.23 | $2,711.54 | $4,698.58 |