- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,533.71 / $4,230.50 / $7,940.20
| Facility | | $2,533.71 | $4,230.50 | $7,940.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,535.92 / $2,983.72 / $4,488.93
| Professional | | $2,535.92 | $2,983.72 | $4,488.93 |
- 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
- $2,617.02 / $3,373.00 / $5,777.59
| Professional | | $2,617.02 | $3,373.00 | $5,777.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $3,246.98
| Facility | | $680.00 | $870.49 | $3,246.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,631.41 / $3,939.07 / $6,619.53
| Professional | | $2,631.41 | $3,939.07 | $6,619.53 |
- 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
- $2,556.86 / $3,498.75 / $6,416.21
| Professional | | $2,556.86 | $3,498.75 | $6,416.21 |