- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.78 / $4,016.58 / $8,074.63
| Facility | | $2,010.78 | $4,016.58 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,890.91 / $2,277.40 / $3,359.70
| Professional | | $1,890.91 | $2,277.40 | $3,359.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,449.50 / $21,253.55
| Facility | | $5,195.00 | $10,449.50 | $21,253.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,963.49 / $2,405.90 / $3,835.49
| Professional | | $1,963.49 | $2,405.90 | $3,835.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,271.00 / $2,271.00 / $3,171.63
| Facility | | $2,271.00 | $2,271.00 | $3,171.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,951.80 / $2,885.18 / $4,766.45
| Professional | | $1,951.80 | $2,885.18 | $4,766.45 |
- 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
- $1,955.47 / $2,819.66 / $4,689.09
| Professional | | $1,955.47 | $2,819.66 | $4,689.09 |