- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,170.12 / $6,607.00 / $10,492.00
| Facility | | $2,170.12 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.33 / $2,170.12 / $3,055.19
| Professional | | $1,176.33 | $2,170.12 | $3,055.19 |
- 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
- $1,272.04 / $2,842.99 / $3,222.36
| Professional | | $1,272.04 | $2,842.99 | $3,222.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.56 / $2,119.19 / $3,485.39
| Professional | | $1,454.56 | $2,119.19 | $3,485.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,804.66 / $1,804.66 / $2,183.83
| Professional | | $1,804.66 | $1,804.66 | $2,183.83 |
- 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
- $1,373.93 / $2,348.91 / $4,163.62
| Professional | | $1,373.93 | $2,348.91 | $4,163.62 |