- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.00 / $3,389.73 / $10,985.00
| Facility | | $1,386.00 | $3,389.73 | $10,985.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.62 / $2,253.00 / $2,803.05
| Professional | | $1,941.62 | $2,253.00 | $2,803.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,778.00 / $48,259.71 / $70,653.03
| Facility | | $5,778.00 | $48,259.71 | $70,653.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,680.11 / $2,247.13 / $3,101.03
| Professional | | $1,680.11 | $2,247.13 | $3,101.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.76 / $2,216.36 / $2,507.19
| Facility | | $2,005.76 | $2,216.36 | $2,507.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.43 / $2,405.63 / $3,687.70
| Professional | | $1,824.43 | $2,405.63 | $3,687.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,475.00 / $14,307.00 / $19,962.00
| Facility | | $6,475.00 | $14,307.00 | $19,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,746.07 / $2,399.50 / $4,267.10
| Professional | | $1,746.07 | $2,399.50 | $4,267.10 |