- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,098.82 / $4,106.59 / $8,016.63
| Facility | | $2,098.82 | $4,106.59 | $8,016.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.22 / $2,349.40 / $3,423.96
| Professional | | $1,950.22 | $2,349.40 | $3,423.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,863.00 / $14,312.00 / $24,194.30
| Facility | | $5,863.00 | $14,312.00 | $24,194.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.67 / $2,515.44 / $3,992.54
| Professional | | $2,058.67 | $2,515.44 | $3,992.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.01 / $2,346.01 / $3,301.50
| Facility | | $2,346.01 | $2,346.01 | $3,301.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,033.54 / $2,970.86 / $5,012.97
| Professional | | $2,033.54 | $2,970.86 | $5,012.97 |
- 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
- $2,006.56 / $2,863.11 / $4,780.29
| Professional | | $2,006.56 | $2,863.11 | $4,780.29 |