- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,401.61 / $4,232.50 / $8,074.63
| Facility | | $2,401.61 | $4,232.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,377.17 / $2,803.88 / $4,362.89
| Professional | | $2,377.17 | $2,803.88 | $4,362.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $21,162.00 / $55,752.34
| Facility | | $8,584.00 | $21,162.00 | $55,752.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,531.58 / $3,714.00 / $5,823.34
| Professional | | $2,531.58 | $3,714.00 | $5,823.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $3,145.79
| Facility | | $895.00 | $950.00 | $3,145.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,675.88 / $3,673.01 / $6,074.18
| Professional | | $2,675.88 | $3,673.01 | $6,074.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $19,562.00
| Facility | | $4,505.00 | $10,133.00 | $19,562.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,427.05 / $3,379.12 / $5,867.15
| Professional | | $2,427.05 | $3,379.12 | $5,867.15 |