- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,103.46 / $4,112.58 / $8,074.63
| Facility | | $2,103.46 | $4,112.58 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,038.09 / $2,263.73 / $3,547.89
| Professional | | $2,038.09 | $2,263.73 | $3,547.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,299.00 / $11,504.00 / $20,791.37
| Facility | | $5,299.00 | $11,504.00 | $20,791.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,071.82 / $2,772.70 / $4,241.03
| Professional | | $2,071.82 | $2,772.70 | $4,241.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,390.84 / $2,390.84 / $3,285.72
| Facility | | $2,390.84 | $2,390.84 | $3,285.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,121.88 / $3,141.90 / $4,956.29
| Professional | | $2,121.88 | $3,141.90 | $4,956.29 |
- 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
- $2,095.76 / $2,970.03 / $5,126.43
| Professional | | $2,095.76 | $2,970.03 | $5,126.43 |