- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,559.48 / $4,165.87 / $8,074.63
| Facility | | $2,559.48 | $4,165.87 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,538.61 / $2,945.46 / $4,843.09
| Professional | | $2,538.61 | $2,945.46 | $4,843.09 |
- 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
- $2,782.00 / $3,627.86 / $5,678.83
| Professional | | $2,782.00 | $3,627.86 | $5,678.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,253.12 / $3,253.12 / $4,538.18
| Facility | | $3,253.12 | $3,253.12 | $4,538.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,895.17 / $4,228.29 / $6,856.75
| Professional | | $2,895.17 | $4,228.29 | $6,856.75 |
- 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
- $2,775.07 / $3,839.92 / $6,828.90
| Professional | | $2,775.07 | $3,839.92 | $6,828.90 |