- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,315.02 / $4,390.84 / $8,074.63
| Facility | | $2,315.02 | $4,390.84 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,243.19 / $2,716.50 / $3,750.25
| Professional | | $2,243.19 | $2,716.50 | $3,750.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,400.00
| Facility | | $5,470.00 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,253.92 / $2,933.64 / $4,627.05
| Professional | | $2,253.92 | $2,933.64 | $4,627.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,603.89 / $2,603.89 / $5,397.20
| Facility | | $2,603.89 | $2,603.89 | $5,397.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,425.59 / $3,372.40 / $5,619.23
| Professional | | $2,425.59 | $3,372.40 | $5,619.23 |
- 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
- $2,299.16 / $3,305.78 / $5,584.52
| Professional | | $2,299.16 | $3,305.78 | $5,584.52 |