- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,256.56 / $4,387.00 / $10,458.00
| Facility | | $2,256.56 | $4,387.00 | $10,458.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.21 / $2,256.56 / $8,385.77
| Professional | | $1,469.21 | $2,256.56 | $8,385.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.81 / $2,248.41 / $3,477.16
| Professional | | $1,515.81 | $2,248.41 | $3,477.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.69 / $909.82 / $1,472.38
| Professional | | $170.69 | $909.82 | $1,472.38 |
- 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
- $2,093.51 / $2,602.05 / $3,722.28
| Professional | | $2,093.51 | $2,602.05 | $3,722.28 |
- 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
- $1,366.41 / $1,727.44 / $2,674.35
| Professional | | $1,366.41 | $1,727.44 | $2,674.35 |