- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,334.75 / $4,139.13 / $7,995.57
| Facility | | $2,334.75 | $4,139.13 | $7,995.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,195.96 / $2,583.76 / $3,886.29
| Professional | | $2,195.96 | $2,583.76 | $3,886.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $8,947.00 / $14,433.40
| Facility | | $3,671.00 | $8,947.00 | $14,433.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,269.91 / $2,916.11 / $4,948.91
| Professional | | $2,269.91 | $2,916.11 | $4,948.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,810.59
| Facility | | $680.00 | $870.49 | $2,810.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,288.96 / $3,410.11 / $5,739.20
| Professional | | $2,288.96 | $3,410.11 | $5,739.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,212.75 / $3,071.69 / $5,416.87
| Professional | | $2,212.75 | $3,071.69 | $5,416.87 |