- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,216.58 / $4,232.50 / $8,074.63
| Facility | | $2,216.58 | $4,232.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,110.09 / $2,451.03 / $3,903.96
| Professional | | $2,110.09 | $2,451.03 | $3,903.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,329.50 / $16,401.00 / $29,216.95
| Facility | | $8,329.50 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,334.83 / $3,026.27 / $4,725.62
| Professional | | $2,334.83 | $3,026.27 | $4,725.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,703.53 / $2,703.53 / $3,774.19
| Facility | | $2,703.53 | $2,703.53 | $3,774.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,402.01 / $3,508.67 / $5,681.38
| Professional | | $2,402.01 | $3,508.67 | $5,681.38 |
- 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
- $2,302.66 / $3,203.52 / $5,933.03
| Professional | | $2,302.66 | $3,203.52 | $5,933.03 |