- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,442.42 / $4,031.36 / $8,238.00
| Facility | | $2,442.42 | $4,031.36 | $8,238.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,465.28 / $2,842.73 / $4,756.22
| Professional | | $2,465.28 | $2,842.73 | $4,756.22 |
- 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
- $2,574.17 / $3,532.56 / $5,576.86
| Professional | | $2,574.17 | $3,532.56 | $5,576.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.50 / $3,193.94 / $4,948.81
| Facility | | $2,278.50 | $3,193.94 | $4,948.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,801.43 / $3,924.38 / $6,193.18
| Professional | | $2,801.43 | $3,924.38 | $6,193.18 |
- 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
- $2,529.10 / $3,683.79 / $6,135.50
| Professional | | $2,529.10 | $3,683.79 | $6,135.50 |