- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.06 / $4,232.50 / $8,074.63
| Facility | | $2,258.06 | $4,232.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,258.17 / $2,566.80 / $4,180.95
| Professional | | $2,258.17 | $2,566.80 | $4,180.95 |
- 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
- $2,316.00 / $3,043.43 / $5,088.74
| Professional | | $2,316.00 | $3,043.43 | $5,088.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,915.15 / $2,915.15 / $4,067.59
| Facility | | $2,915.15 | $2,915.15 | $4,067.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,342.21 / $3,506.53 / $5,531.18
| Professional | | $2,342.21 | $3,506.53 | $5,531.18 |
- 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
- $2,312.04 / $3,283.83 / $5,977.39
| Professional | | $2,312.04 | $3,283.83 | $5,977.39 |