- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.28 / $4,002.33 / $8,074.63
| Facility | | $2,402.28 | $4,002.33 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,431.31 / $2,795.39 / $4,710.14
| Professional | | $2,431.31 | $2,795.39 | $4,710.14 |
- 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
- $2,538.11 / $3,473.08 / $5,484.45
| Professional | | $2,538.11 | $3,473.08 | $5,484.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.50 / $3,140.83 / $4,912.00
| Facility | | $2,278.50 | $3,140.83 | $4,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.69 / $3,859.39 / $6,090.30
| Professional | | $2,754.69 | $3,859.39 | $6,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $8,848.00 / $19,168.00
| Facility | | $5,028.00 | $8,848.00 | $19,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,444.90 / $3,586.31 / $6,190.52
| Professional | | $2,444.90 | $3,586.31 | $6,190.52 |