- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,338.94 / $3,780.50 / $8,074.63
| Facility | | $2,338.94 | $3,780.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,307.05 / $2,665.17 / $4,488.95
| Professional | | $2,307.05 | $2,665.17 | $4,488.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,184.00 / $28,048.48
| Facility | | $7,754.10 | $16,184.00 | $28,048.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,443.54 / $3,297.13 / $5,232.81
| Professional | | $2,443.54 | $3,297.13 | $5,232.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.50 / $2,995.12 / $4,890.73
| Facility | | $2,278.50 | $2,995.12 | $4,890.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,626.35 / $3,759.00 / $5,808.04
| Professional | | $2,626.35 | $3,759.00 | $5,808.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,269.00 / $7,384.00
| Facility | | $1,185.00 | $3,269.00 | $7,384.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,372.10 / $3,397.59 / $5,939.29
| Professional | | $2,372.10 | $3,397.59 | $5,939.29 |