- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,305.00 / $6,607.00 / $10,492.00
| Facility | | $4,305.00 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,704.33 / $4,713.60 / $7,674.13
| Professional | | $3,704.33 | $4,713.60 | $7,674.13 |
- 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
- $2,763.73 / $6,296.03 / $7,205.45
| Professional | | $2,763.73 | $6,296.03 | $7,205.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,161.78 / $3,762.67 / $7,571.66
| Professional | | $3,161.78 | $3,762.67 | $7,571.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,009.29 / $4,009.29 / $4,729.67
| Professional | | $4,009.29 | $4,009.29 | $4,729.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,275.00 / $5,345.00 / $14,963.00
| Facility | | $3,275.00 | $5,345.00 | $14,963.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,012.04 / $4,617.41 / $9,099.12
| Professional | | $3,012.04 | $4,617.41 | $9,099.12 |