- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,328.07 / $6,607.00 / $10,492.00
| Facility | | $3,328.07 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.32 / $2,979.07 / $4,634.34
| Professional | | $1,819.32 | $2,979.07 | $4,634.34 |
- 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
- $1,954.65 / $4,486.78 / $5,134.87
| Professional | | $1,954.65 | $4,486.78 | $5,134.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,221.91 / $2,612.41 / $5,344.77
| Professional | | $2,221.91 | $2,612.41 | $5,344.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,804.96 / $2,804.96 / $3,324.78
| Professional | | $2,804.96 | $2,804.96 | $3,324.78 |
- 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
- $2,123.15 / $3,680.05 / $7,688.97
| Professional | | $2,123.15 | $3,680.05 | $7,688.97 |