- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.84 / $6,607.00 / $10,492.00
| Facility | | $2,016.84 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,632.87 / $2,016.84 / $2,893.28
| Professional | | $1,632.87 | $2,016.84 | $2,893.28 |
- 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
- $1,082.99 / $2,696.53 / $3,199.31
| Professional | | $1,082.99 | $2,696.53 | $3,199.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.43 / $1,922.15 / $2,900.30
| Professional | | $1,332.43 | $1,922.15 | $2,900.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.45 / $1,772.45 / $1,828.44
| Professional | | $1,772.45 | $1,772.45 | $1,828.44 |
- 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
- $1,174.72 / $2,027.37 / $5,420.10
| Professional | | $1,174.72 | $2,027.37 | $5,420.10 |