- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.80 / $4,117.49 / $8,074.63
| Facility | | $2,059.80 | $4,117.49 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.13 / $2,208.89 / $3,416.50
| Professional | | $1,943.13 | $2,208.89 | $3,416.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,329.50 / $16,401.00 / $29,216.95
| Facility | | $8,329.50 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,165.04 / $2,774.01 / $4,382.85
| Professional | | $2,165.04 | $2,774.01 | $4,382.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,506.98 / $2,506.98 / $3,501.83
| Facility | | $2,506.98 | $2,506.98 | $3,501.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,231.51 / $3,257.50 / $5,260.92
| Professional | | $2,231.51 | $3,257.50 | $5,260.92 |
- 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
- $2,157.40 / $2,954.90 / $5,403.74
| Professional | | $2,157.40 | $2,954.90 | $5,403.74 |