- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.56 / $4,804.00 / $10,620.21
| Facility | | $2,147.56 | $4,804.00 | $10,620.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,930.08 / $2,262.04 / $3,451.00
| Professional | | $1,930.08 | $2,262.04 | $3,451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.00 / $23,200.00 / $69,197.00
| Facility | | $8,407.00 | $23,200.00 | $69,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.94 / $2,851.50 / $4,605.61
| Professional | | $2,097.94 | $2,851.50 | $4,605.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,490.91
| Facility | | $895.00 | $950.00 | $2,490.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,218.87 / $3,230.86 / $4,849.64
| Professional | | $2,218.87 | $3,230.86 | $4,849.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $19,689.00
| Facility | | $4,505.00 | $10,133.00 | $19,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,999.08 / $2,835.97 / $4,992.71
| Professional | | $1,999.08 | $2,835.97 | $4,992.71 |