- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,301.92 / $4,366.31 / $8,074.63
| Facility | | $2,301.92 | $4,366.31 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,210.84 / $2,671.70 / $3,699.44
| Professional | | $2,210.84 | $2,671.70 | $3,699.44 |
- 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
- $2,222.64 / $2,896.51 / $4,641.72
| Professional | | $2,222.64 | $2,896.51 | $4,641.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,566.37 / $2,566.37 / $5,374.33
| Facility | | $2,566.37 | $2,566.37 | $5,374.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,512.92 / $3,352.73 / $5,524.18
| Professional | | $2,512.92 | $3,352.73 | $5,524.18 |
- 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
- $2,262.81 / $3,187.06 / $5,589.87
| Professional | | $2,262.81 | $3,187.06 | $5,589.87 |