- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.58 / $4,074.77 / $8,074.63
| Facility | | $2,021.58 | $4,074.77 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.59 / $2,236.33 / $3,547.85
| Professional | | $1,944.59 | $2,236.33 | $3,547.85 |
- 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
- $2,127.08 / $2,741.52 / $4,309.45
| Professional | | $2,127.08 | $2,741.52 | $4,309.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,463.73 / $2,463.73 / $3,441.89
| Facility | | $2,463.73 | $2,463.73 | $3,441.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,186.02 / $3,184.73 / $5,169.51
| Professional | | $2,186.02 | $3,184.73 | $5,169.51 |
- 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
- $2,093.66 / $2,903.56 / $5,256.83
| Professional | | $2,093.66 | $2,903.56 | $5,256.83 |