- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.40 / $3,889.50 / $8,074.63
| Facility | | $1,806.40 | $3,889.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,740.13 / $1,915.12 / $3,034.61
| Professional | | $1,740.13 | $1,915.12 | $3,034.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,274.72 / $8,683.04 / $13,628.92
| Facility | | $4,274.72 | $8,683.04 | $13,628.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,769.18 / $2,398.21 / $3,624.49
| Professional | | $1,769.18 | $2,398.21 | $3,624.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,042.54 / $2,042.54 / $2,807.77
| Facility | | $2,042.54 | $2,042.54 | $2,807.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.96 / $2,682.31 / $4,261.60
| Professional | | $1,829.96 | $2,682.31 | $4,261.60 |
- 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
- $1,804.91 / $2,471.90 / $4,081.49
| Professional | | $1,804.91 | $2,471.90 | $4,081.49 |