- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.81 / $5,063.00 / $7,421.00
| Facility | | $2,052.81 | $5,063.00 | $7,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,561.95 / $2,025.04 / $4,955.22
| Professional | | $1,561.95 | $2,025.04 | $4,955.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,360.54 / $6,994.14 / $13,137.87
| Facility | | $2,360.54 | $6,994.14 | $13,137.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,822.97 / $2,039.19 / $3,494.27
| Professional | | $1,822.97 | $2,039.19 | $3,494.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,635.00 / $15,635.00 / $15,635.00
| Facility | | $15,635.00 | $15,635.00 | $15,635.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,504.94 / $7,156.42 / $10,459.39
| Professional | | $5,504.94 | $7,156.42 | $10,459.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.00 / $10,242.00 / $20,037.00
| Facility | | $2,303.00 | $10,242.00 | $20,037.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,206.57 / $1,610.60 / $8,319.96
| Professional | | $1,206.57 | $1,610.60 | $8,319.96 |