- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,688.00 / $9,034.00
| Facility | | $1,277.00 | $1,688.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.36 / $1,488.71 / $1,943.25
| Professional | | $1,106.36 | $1,488.71 | $1,943.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,270.34 / $13,270.34 / $15,924.41
| Facility | | $13,270.34 | $13,270.34 | $15,924.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.32 / $1,665.41 / $1,763.37
| Professional | | $1,332.32 | $1,665.41 | $1,763.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,945.86 / $8,945.86 / $8,945.86
| Facility | | $8,945.86 | $8,945.86 | $8,945.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.38 / $1,837.79 / $2,329.91
| Professional | | $1,353.38 | $1,837.79 | $2,329.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,663.00 / $10,818.00
| Facility | | $2,104.00 | $4,663.00 | $10,818.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.48 / $1,592.85 / $2,352.64
| Professional | | $1,127.48 | $1,592.85 | $2,352.64 |