- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,724.14 / $6,607.00 / $10,492.00
| Facility | | $1,724.14 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.48 / $1,724.14 / $2,440.61
| Professional | | $1,056.48 | $1,724.14 | $2,440.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,098.00 / $12,905.00 / $17,206.00
| Facility | | $12,098.00 | $12,905.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.33 / $1,973.04 / $2,340.92
| Professional | | $934.33 | $1,973.04 | $2,340.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.18 / $1,402.09 / $2,600.58
| Professional | | $1,058.18 | $1,402.09 | $2,600.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.73 / $1,576.09 / $1,576.09
| Professional | | $1,290.73 | $1,576.09 | $1,576.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,275.00 / $6,137.00 / $16,193.00
| Facility | | $3,275.00 | $6,137.00 | $16,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.52 / $1,488.60 / $2,635.94
| Professional | | $984.52 | $1,488.60 | $2,635.94 |