- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,373.01 / $4,510.50 / $9,795.50
| Facility | | $2,373.01 | $4,510.50 | $9,795.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,203.17 / $2,531.46 / $3,139.72
| Professional | | $2,203.17 | $2,531.46 | $3,139.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,196.00 / $11,262.00
| Facility | | $3,302.10 | $5,196.00 | $11,262.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,067.50 / $2,557.16 / $4,161.81
| Professional | | $2,067.50 | $2,557.16 | $4,161.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,742.73 / $2,742.73 / $2,998.72
| Facility | | $2,742.73 | $2,742.73 | $2,998.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,236.42 / $3,208.71 / $5,370.64
| Professional | | $2,236.42 | $3,208.71 | $5,370.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.00 / $5,179.50 / $9,716.00
| Facility | | $2,293.00 | $5,179.50 | $9,716.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,236.41 / $2,986.25 / $5,319.78
| Professional | | $2,236.41 | $2,986.25 | $5,319.78 |