- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,254.80 / $4,264.41 / $8,074.63
| Facility | | $2,254.80 | $4,264.41 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,083.16 / $2,559.15 / $3,465.26
| Professional | | $2,083.16 | $2,559.15 | $3,465.26 |
- 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
- $2,123.09 / $2,764.38 / $4,390.80
| Professional | | $2,123.09 | $2,764.38 | $4,390.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,453.00 / $2,453.00 / $5,294.14
| Facility | | $2,453.00 | $2,453.00 | $5,294.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,334.52 / $3,177.01 / $5,330.36
| Professional | | $2,334.52 | $3,177.01 | $5,330.36 |
- 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
- $2,165.44 / $3,101.15 / $5,395.37
| Professional | | $2,165.44 | $3,101.15 | $5,395.37 |