- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,055.08 / $4,105.23 / $8,074.63
| Facility | | $2,055.08 | $4,105.23 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.15 / $2,261.54 / $3,598.14
| Professional | | $1,949.15 | $2,261.54 | $3,598.14 |
- 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
- $2,153.05 / $2,769.72 / $4,357.95
| Professional | | $2,153.05 | $2,769.72 | $4,357.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,494.13 / $2,494.13 / $3,483.43
| Facility | | $2,494.13 | $2,494.13 | $3,483.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,227.67 / $3,241.46 / $5,175.35
| Professional | | $2,227.67 | $3,241.46 | $5,175.35 |
- 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
- $2,184.77 / $2,944.02 / $5,242.85
| Professional | | $2,184.77 | $2,944.02 | $5,242.85 |