- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,740.52 / $4,387.00 / $8,344.00
| Facility | | $1,740.52 | $4,387.00 | $8,344.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.58 / $1,740.52 / $6,736.55
| Professional | | $1,198.58 | $1,740.52 | $6,736.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.15 / $1,783.79 / $2,818.82
| Professional | | $1,260.15 | $1,783.79 | $2,818.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.43 / $748.12 / $1,219.52
| Professional | | $123.43 | $748.12 | $1,219.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,314.50 / $25,330.44 / $36,365.48
| Facility | | $20,314.50 | $25,330.44 | $36,365.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,705.79 / $2,079.19 / $2,977.48
| Professional | | $1,705.79 | $2,079.19 | $2,977.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $9,753.00 / $15,824.00
| Facility | | $3,028.00 | $9,753.00 | $15,824.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.14 / $1,304.86 / $2,179.52
| Professional | | $1,109.14 | $1,304.86 | $2,179.52 |