- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,300.02 / $4,366.40 / $8,364.50
| Facility | | $2,300.02 | $4,366.40 | $8,364.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,232.17 / $2,657.58 / $3,584.16
| Professional | | $2,232.17 | $2,657.58 | $3,584.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,540.00 / $9,992.00 / $17,206.00
| Facility | | $5,540.00 | $9,992.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.27 / $2,981.83 / $4,491.78
| Professional | | $2,248.27 | $2,981.83 | $4,491.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,572.06 / $2,572.06 / $5,368.81
| Facility | | $2,572.06 | $2,572.06 | $5,368.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,421.44 / $3,466.45 / $5,803.76
| Professional | | $2,421.44 | $3,466.45 | $5,803.76 |
- 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
- $2,413.81 / $3,839.36 / $6,222.06
| Professional | | $2,413.81 | $3,839.36 | $6,222.06 |