- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,579.06 / $4,232.50 / $8,074.63
| Facility | | $2,579.06 | $4,232.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,527.55 / $2,808.10 / $4,372.93
| Professional | | $2,527.55 | $2,808.10 | $4,372.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,563.80 / $3,586.31 / $5,453.10
| Professional | | $2,563.80 | $3,586.31 | $5,453.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.50 / $3,054.50 / $4,283.68
| Facility | | $3,054.50 | $3,054.50 | $4,283.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,717.64 / $3,878.13 / $6,196.66
| Professional | | $2,717.64 | $3,878.13 | $6,196.66 |
- 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
- $2,571.28 / $3,668.15 / $6,544.64
| Professional | | $2,571.28 | $3,668.15 | $6,544.64 |