- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,617.47 / $4,213.21 / $8,074.63
| Facility | | $2,617.47 | $4,213.21 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,675.71 / $3,063.07 / $4,988.54
| Professional | | $2,675.71 | $3,063.07 | $4,988.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,104.00 / $28,048.48
| Facility | | $7,754.10 | $16,104.00 | $28,048.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,801.22 / $3,845.75 / $6,051.97
| Professional | | $2,801.22 | $3,845.75 | $6,051.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.50 / $3,467.87 / $5,138.62
| Facility | | $2,278.50 | $3,467.87 | $5,138.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,042.05 / $4,290.17 / $6,724.58
| Professional | | $3,042.05 | $4,290.17 | $6,724.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $19,562.00
| Facility | | $4,505.00 | $10,133.00 | $19,562.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,706.18 / $3,966.96 / $6,671.72
| Professional | | $2,706.18 | $3,966.96 | $6,671.72 |