- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,626.00 / $8,084.00 / $13,451.00
| Facility | | $2,626.00 | $8,084.00 | $13,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.83 / $1,212.92 / $1,485.99
| Professional | | $1,013.83 | $1,212.92 | $1,485.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,555.57 / $13,861.54 / $30,058.58
| Facility | | $11,555.57 | $13,861.54 | $30,058.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.25 / $1,448.45 / $2,487.11
| Professional | | $1,014.25 | $1,448.45 | $2,487.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,682.00 / $8,475.00 / $14,134.00
| Facility | | $5,682.00 | $8,475.00 | $14,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.38 / $1,250.50 / $2,772.46
| Professional | | $1,013.38 | $1,250.50 | $2,772.46 |