- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,276.78 / $6,607.00 / $10,492.00
| Facility | | $2,276.78 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,629.37 / $2,276.78 / $3,027.04
| Professional | | $1,629.37 | $2,276.78 | $3,027.04 |
- 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
- $1,159.56 / $2,751.77 / $3,138.84
| Professional | | $1,159.56 | $2,751.77 | $3,138.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.18 / $2,004.84 / $3,161.05
| Professional | | $1,365.18 | $2,004.84 | $3,161.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,760.70 / $1,760.70 / $1,967.40
| Professional | | $1,760.70 | $1,760.70 | $1,967.40 |
- 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
- $1,175.71 / $2,109.55 / $4,580.43
| Professional | | $1,175.71 | $2,109.55 | $4,580.43 |