- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.41 / $3,621.61 / $3,737.58
| Facility | | $2,448.41 | $3,621.61 | $3,737.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.41 / $3,017.14 / $5,100.85
| Professional | | $2,448.41 | $3,017.14 | $5,100.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,359.08 / $5,627.03 / $24,737.51
| Facility | | $5,359.08 | $5,627.03 | $24,737.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,980.39 / $3,194.59 / $4,337.76
| Professional | | $2,980.39 | $3,194.59 | $4,337.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,943.38 / $3,943.38 / $3,943.38
| Facility | | $3,943.38 | $3,943.38 | $3,943.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,878.67 / $2,878.67 / $4,061.68
| Professional | | $2,878.67 | $2,878.67 | $4,061.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.41 / $4,318.97 / $27,719.31
| Facility | | $2,448.41 | $4,318.97 | $27,719.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,184.02 / $2,910.30 / $5,385.13
| Professional | | $2,184.02 | $2,910.30 | $5,385.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,040.34 / $2,693.90 / $4,038.60
| Professional | | $2,040.34 | $2,693.90 | $4,038.60 |