- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.62 / $4,735.00 / $10,057.21
| Facility | | $2,430.62 | $4,735.00 | $10,057.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,237.54 / $2,546.06 / $4,188.71
| Professional | | $2,237.54 | $2,546.06 | $4,188.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.00 / $21,162.00 / $55,752.34
| Facility | | $8,407.00 | $21,162.00 | $55,752.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.32 / $3,313.88 / $5,171.98
| Professional | | $2,366.32 | $3,313.88 | $5,171.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,802.44
| Facility | | $895.00 | $950.00 | $2,802.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,543.02 / $3,729.18 / $5,565.33
| Professional | | $2,543.02 | $3,729.18 | $5,565.33 |
- 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
- $2,249.14 / $3,233.00 / $5,612.61
| Professional | | $2,249.14 | $3,233.00 | $5,612.61 |