- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,664.06 / $6,607.00 / $10,492.00
| Facility | | $3,664.06 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,361.87 / $3,664.06 / $5,309.54
| Professional | | $2,361.87 | $3,664.06 | $5,309.54 |
- 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
- $2,022.20 / $4,825.71 / $5,481.42
| Professional | | $2,022.20 | $4,825.71 | $5,481.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,353.07 / $3,531.40 / $5,568.00
| Professional | | $2,353.07 | $3,531.40 | $5,568.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,561.26 / $2,561.26 / $3,446.89
| Professional | | $2,561.26 | $2,561.26 | $3,446.89 |
- 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
- $2,197.86 / $3,369.25 / $8,014.73
| Professional | | $2,197.86 | $3,369.25 | $8,014.73 |