- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,562.00 / $5,063.00 / $7,421.00
| Facility | | $3,562.00 | $5,063.00 | $7,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,520.06 / $4,215.28 / $5,465.25
| Professional | | $3,520.06 | $4,215.28 | $5,465.25 |
- 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
- $1,623.93 / $1,957.62 / $3,773.23
| Professional | | $1,623.93 | $1,957.62 | $3,773.23 |
- 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
- $5,702.87 / $7,413.73 / $10,835.45
| Professional | | $5,702.87 | $7,413.73 | $10,835.45 |
- 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
- $1,074.75 / $1,537.27 / $7,023.53
| Professional | | $1,074.75 | $1,537.27 | $7,023.53 |