- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,230.01 / $4,216.48 / $8,074.63
| Facility | | $2,230.01 | $4,216.48 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,038.70 / $2,461.81 / $3,413.64
| Professional | | $2,038.70 | $2,461.81 | $3,413.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $9,992.00 / $17,206.00
| Facility | | $4,755.00 | $9,992.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.85 / $2,792.59 / $4,442.85
| Professional | | $2,049.85 | $2,792.59 | $4,442.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.28 / $2,368.28 / $5,239.20
| Facility | | $2,368.28 | $2,368.28 | $5,239.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,309.15 / $3,136.95 / $5,134.78
| Professional | | $2,309.15 | $3,136.95 | $5,134.78 |
- 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
- $2,123.11 / $3,006.15 / $5,070.22
| Professional | | $2,123.11 | $3,006.15 | $5,070.22 |