- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,493.00 / $9,034.00
| Facility | | $1,277.00 | $2,493.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,364.75 / $3,270.39 / $3,586.92
| Professional | | $2,364.75 | $3,270.39 | $3,586.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.30 / $6,727.30 / $8,072.76
| Facility | | $6,727.30 | $6,727.30 | $8,072.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,972.62 / $3,715.78 / $3,934.35
| Professional | | $2,972.62 | $3,715.78 | $3,934.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,300.36 / $5,300.36 / $5,300.36
| Facility | | $5,300.36 | $5,300.36 | $5,300.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,820.79 / $4,199.27 / $5,223.93
| Professional | | $2,820.79 | $4,199.27 | $5,223.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,555.00 / $8,676.00
| Facility | | $2,104.00 | $4,555.00 | $8,676.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,273.48 / $3,192.66 / $5,290.53
| Professional | | $2,273.48 | $3,192.66 | $5,290.53 |