- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,386.01 / $9,813.00 / $14,552.94
| Facility | | $6,386.01 | $9,813.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.22 / $6,386.01 / $10,830.89
| Professional | | $2,001.22 | $6,386.01 | $10,830.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,477.80 / $7,408.03 / $9,432.06
| Professional | | $5,477.80 | $7,408.03 | $9,432.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.77 / $10,830.89 / $15,163.25
| Facility | | $2,070.77 | $10,830.89 | $15,163.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,371.95 / $6,446.34 / $13,086.71
| Professional | | $5,371.95 | $6,446.34 | $13,086.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,977.50 / $10,946.30 / $13,362.00
| Professional | | $7,977.50 | $10,946.30 | $13,362.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.77 / $10,830.89 / $15,163.25
| Facility | | $2,070.77 | $10,830.89 | $15,163.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,290.94 / $10,853.50 / $14,020.60
| Professional | | $3,290.94 | $10,853.50 | $14,020.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,831.32 / $11,831.32 / $11,831.32
| Facility | | $11,831.32 | $11,831.32 | $11,831.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,884.42 / $10,371.24 / $13,038.12
| Professional | | $5,884.42 | $10,371.24 | $13,038.12 |