- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,795.06 / $7,629.00 / $16,024.38
| Facility | | $2,795.06 | $7,629.00 | $16,024.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,368.32 / $2,795.06 / $5,516.44
| Professional | | $2,368.32 | $2,795.06 | $5,516.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,633.00 / $15,243.32 / $23,168.00
| Facility | | $8,633.00 | $15,243.32 | $23,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,923.12 / $3,284.32 / $3,896.70
| Professional | | $1,923.12 | $3,284.32 | $3,896.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,697.33 / $3,524.41 / $6,815.64
| Professional | | $2,697.33 | $3,524.41 | $6,815.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.83 / $3,623.75 / $3,623.75
| Professional | | $2,335.83 | $3,623.75 | $3,623.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,944.00 / $10,417.00 / $16,323.00
| Facility | | $5,944.00 | $10,417.00 | $16,323.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,078.60 / $3,301.06 / $5,814.01
| Professional | | $2,078.60 | $3,301.06 | $5,814.01 |