- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.00 / $4,387.00 / $10,458.00
| Facility | | $3,294.00 | $4,387.00 | $10,458.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,266.48 / $3,908.05 / $12,947.60
| Professional | | $2,266.48 | $3,908.05 | $12,947.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,733.23 / $3,720.08 / $6,936.80
| Professional | | $2,733.23 | $3,720.08 | $6,936.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.02 / $1,552.53 / $2,320.04
| Professional | | $227.02 | $1,552.53 | $2,320.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.20 / $32,053.62 / $46,017.58
| Facility | | $25,703.20 | $32,053.62 | $46,017.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,020.33 / $4,559.60 / $7,947.42
| Professional | | $4,020.33 | $4,559.60 | $7,947.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $10,927.00 / $24,613.00
| Facility | | $3,340.00 | $10,927.00 | $24,613.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,211.14 / $2,883.20 / $4,232.34
| Professional | | $2,211.14 | $2,883.20 | $4,232.34 |