- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.03 / $4,157.47 / $8,074.63
| Facility | | $2,005.03 | $4,157.47 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,840.87 / $2,202.35 / $3,058.14
| Professional | | $1,840.87 | $2,202.35 | $3,058.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $9,992.00 / $17,206.00
| Facility | | $4,755.00 | $9,992.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.42 / $2,521.80 / $3,685.48
| Professional | | $1,847.42 | $2,521.80 | $3,685.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.44 / $2,143.44 / $5,072.25
| Facility | | $2,143.44 | $2,143.44 | $5,072.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,079.17 / $2,831.10 / $4,507.68
| Professional | | $2,079.17 | $2,831.10 | $4,507.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.50 / $3,324.00 / $8,175.00
| Facility | | $1,283.50 | $3,324.00 | $8,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,938.78 / $2,792.50 / $4,782.68
| Professional | | $1,938.78 | $2,792.50 | $4,782.68 |