- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,276.32 / $3,038.00 / $4,387.00
| Facility | | $2,276.32 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.28 / $2,276.32 / $8,471.43
| Professional | | $1,490.28 | $2,276.32 | $8,471.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.06 / $2,252.09 / $4,592.68
| Professional | | $1,625.06 | $2,252.09 | $4,592.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.34 / $913.58 / $1,516.56
| Professional | | $138.34 | $913.58 | $1,516.56 |
- 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
- $2,124.41 / $2,538.12 / $3,882.76
| Professional | | $2,124.41 | $2,538.12 | $3,882.76 |
- 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
- $1,367.80 / $1,716.81 / $2,835.38
| Professional | | $1,367.80 | $1,716.81 | $2,835.38 |