- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $4,391.50 / $8,167.12
| Facility | | $2,747.00 | $4,391.50 | $8,167.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,949.42 / $3,427.23 / $5,417.15
| Professional | | $2,949.42 | $3,427.23 | $5,417.15 |
- 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
- $3,060.96 / $4,117.37 / $6,555.80
| Professional | | $3,060.96 | $4,117.37 | $6,555.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,737.35 / $3,737.35 / $5,236.97
| Facility | | $3,737.35 | $3,737.35 | $5,236.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,291.81 / $4,731.79 / $7,363.63
| Professional | | $3,291.81 | $4,731.79 | $7,363.63 |
- 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
- $3,195.50 / $4,474.43 / $7,986.15
| Professional | | $3,195.50 | $4,474.43 | $7,986.15 |