- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $4,472.00 / $8,426.55
| Facility | | $2,747.00 | $4,472.00 | $8,426.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,917.73 / $3,581.21 / $5,132.46
| Professional | | $2,917.73 | $3,581.21 | $5,132.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $9,992.00 / $17,206.00
| Facility | | $4,989.00 | $9,992.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,129.84 / $4,085.69 / $6,192.65
| Professional | | $3,129.84 | $4,085.69 | $6,192.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,615.50 / $3,615.50 / $7,227.90
| Facility | | $3,615.50 | $3,615.50 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,309.01 / $4,670.89 / $7,768.09
| Professional | | $3,309.01 | $4,670.89 | $7,768.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,089.46 / $4,487.05 / $7,959.79
| Professional | | $3,089.46 | $4,487.05 | $7,959.79 |