- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,168.79 / $4,228.89 / $8,074.63
| Facility | | $2,168.79 | $4,228.89 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.39 / $2,397.75 / $3,813.51
| Professional | | $2,062.39 | $2,397.75 | $3,813.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,925.33
| Facility | | $8,105.25 | $16,184.00 | $28,925.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,282.23 / $2,918.43 / $4,621.65
| Professional | | $2,282.23 | $2,918.43 | $4,621.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,644.27 / $2,644.27 / $3,692.17
| Facility | | $2,644.27 | $2,644.27 | $3,692.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,350.58 / $3,439.00 / $5,522.42
| Professional | | $2,350.58 | $3,439.00 | $5,522.42 |
- 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
- $2,253.96 / $3,180.06 / $5,547.32
| Professional | | $2,253.96 | $3,180.06 | $5,547.32 |