- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,213.66 / $6,607.00 / $10,492.00
| Facility | | $3,213.66 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,228.54 / $3,213.66 / $4,674.68
| Professional | | $2,228.54 | $3,213.66 | $4,674.68 |
- 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
- $1,900.07 / $4,273.84 / $4,891.18
| Professional | | $1,900.07 | $4,273.84 | $4,891.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,131.41 / $3,354.14 / $5,596.22
| Professional | | $2,131.41 | $3,354.14 | $5,596.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,157.33 / $3,157.33 / $3,157.33
| Professional | | $3,157.33 | $3,157.33 | $3,157.33 |
- 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
- $2,049.82 / $3,596.16 / $6,165.39
| Professional | | $2,049.82 | $3,596.16 | $6,165.39 |