- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.00 / $3,509.00 / $7,674.00
| Facility | | $1,862.00 | $3,509.00 | $7,674.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.65 / $1,350.23 / $1,925.57
| Professional | | $1,055.65 | $1,350.23 | $1,925.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $8,455.00 / $14,510.00
| Facility | | $6,996.00 | $8,455.00 | $14,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.19 / $1,676.07 / $2,926.00
| Professional | | $1,335.19 | $1,676.07 | $2,926.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $5,378.18 / $7,710.35
| Professional | | $200.00 | $5,378.18 | $7,710.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,895.11 / $7,895.11 / $7,895.11
| Facility | | $7,895.11 | $7,895.11 | $7,895.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.00 / $3,060.00 / $9,042.00
| Facility | | $1,642.00 | $3,060.00 | $9,042.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.16 / $1,711.41 / $2,493.87
| Professional | | $1,204.16 | $1,711.41 | $2,493.87 |