- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,240.72 / $4,231.36 / $8,074.63
| Facility | | $2,240.72 | $4,231.36 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,023.83 / $2,491.38 / $3,366.56
| Professional | | $2,023.83 | $2,491.38 | $3,366.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,400.00
| Facility | | $5,470.00 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,063.83 / $2,791.76 / $4,345.47
| Professional | | $2,063.83 | $2,791.76 | $4,345.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,384.50 / $2,384.50 / $5,248.92
| Facility | | $2,384.50 | $2,384.50 | $5,248.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,319.04 / $3,159.25 / $5,175.70
| Professional | | $2,319.04 | $3,159.25 | $5,175.70 |
- 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
- $2,124.79 / $3,025.65 / $5,143.09
| Professional | | $2,124.79 | $3,025.65 | $5,143.09 |