- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.69 / $4,232.50 / $8,074.63
| Facility | | $2,347.69 | $4,232.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,256.92 / $2,492.91 / $3,971.15
| Professional | | $2,256.92 | $2,492.91 | $3,971.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,410.32 / $3,217.86 / $4,781.28
| Professional | | $2,410.32 | $3,217.86 | $4,781.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,762.82 / $2,762.82 / $3,843.60
| Facility | | $2,762.82 | $2,762.82 | $3,843.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,552.25 / $3,605.15 / $6,054.14
| Professional | | $2,552.25 | $3,605.15 | $6,054.14 |
- 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
- $2,464.28 / $3,403.53 / $5,920.41
| Professional | | $2,464.28 | $3,403.53 | $5,920.41 |