- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,556.45 / $4,232.50 / $8,074.63
| Facility | | $2,556.45 | $4,232.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,571.64 / $2,979.55 / $4,775.63
| Professional | | $2,571.64 | $2,979.55 | $4,775.63 |
- 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
- $2,660.52 / $3,444.54 / $5,721.10
| Professional | | $2,660.52 | $3,444.54 | $5,721.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,234.07 / $3,234.07 / $4,551.85
| Facility | | $3,234.07 | $3,234.07 | $4,551.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,728.34 / $4,074.40 / $6,652.59
| Professional | | $2,728.34 | $4,074.40 | $6,652.59 |
- 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
- $2,737.68 / $3,834.49 / $6,950.66
| Professional | | $2,737.68 | $3,834.49 | $6,950.66 |