- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,839.52 / $6,607.00 / $10,492.00
| Facility | | $2,839.52 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.89 / $2,416.88 / $3,785.01
| Professional | | $1,550.89 | $2,416.88 | $3,785.01 |
- 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
- $1,503.06 / $3,884.35 / $4,445.43
| Professional | | $1,503.06 | $3,884.35 | $4,445.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,914.21 / $2,824.76 / $4,524.20
| Professional | | $1,914.21 | $2,824.76 | $4,524.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,394.33 / $2,394.33 / $2,826.32
| Professional | | $2,394.33 | $2,394.33 | $2,826.32 |
- 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
- $1,800.51 / $2,760.61 / $5,440.10
| Professional | | $1,800.51 | $2,760.61 | $5,440.10 |