- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,405.80 / $6,607.00 / $10,492.00
| Facility | | $2,405.80 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,923.16 / $2,405.80 / $3,485.36
| Professional | | $1,923.16 | $2,405.80 | $3,485.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,703.45 / $11,230.09 / $13,227.00
| Facility | | $8,703.45 | $11,230.09 | $13,227.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.13 / $3,225.78 / $3,656.24
| Professional | | $1,425.13 | $3,225.78 | $3,656.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,624.34 / $2,341.88 / $3,901.32
| Professional | | $1,624.34 | $2,341.88 | $3,901.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,088.51 / $2,088.51 / $2,187.46
| Professional | | $2,088.51 | $2,088.51 | $2,187.46 |
- 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
- $1,483.09 / $2,826.02 / $5,618.05
| Professional | | $1,483.09 | $2,826.02 | $5,618.05 |