- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.79 / $4,487.00 / $9,248.34
| Facility | | $2,008.79 | $4,487.00 | $9,248.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.04 / $2,138.46 / $3,471.86
| Professional | | $1,969.04 | $2,138.46 | $3,471.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,363.00 / $12,274.00
| Facility | | $4,452.00 | $7,363.00 | $12,274.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,106.44 / $2,550.92 / $4,218.60
| Professional | | $2,106.44 | $2,550.92 | $4,218.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.44 / $2,402.44 / $5,411.81
| Facility | | $2,402.44 | $2,402.44 | $5,411.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,151.58 / $3,109.42 / $5,236.53
| Professional | | $2,151.58 | $3,109.42 | $5,236.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,080.16 / $2,890.69 / $4,812.55
| Professional | | $2,080.16 | $2,890.69 | $4,812.55 |