- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.00 / $4,347.46 / $8,074.63
| Facility | | $2,249.00 | $4,347.46 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,127.64 / $2,521.73 / $3,364.04
| Professional | | $2,127.64 | $2,521.73 | $3,364.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $8,981.00 / $15,216.00
| Facility | | $4,769.10 | $8,981.00 | $15,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,816.30 / $2,495.59 / $4,199.84
| Professional | | $1,816.30 | $2,495.59 | $4,199.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,514.66 / $2,514.66 / $5,350.40
| Facility | | $2,514.66 | $2,514.66 | $5,350.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,691.00 / $3,083.46 / $5,061.45
| Professional | | $1,691.00 | $3,083.46 | $5,061.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.00 / $3,324.00 / $7,965.00
| Facility | | $1,339.00 | $3,324.00 | $7,965.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,611.85 / $2,623.16 / $5,183.24
| Professional | | $1,611.85 | $2,623.16 | $5,183.24 |