- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,378.76 / $6,607.00 / $10,492.00
| Facility | | $2,378.76 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,766.92 / $2,378.76 / $3,123.44
| Professional | | $1,766.92 | $2,378.76 | $3,123.44 |
- 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
- $1,283.68 / $3,019.49 / $3,422.42
| Professional | | $1,283.68 | $3,019.49 | $3,422.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,476.50 / $1,859.63 / $3,443.13
| Professional | | $1,476.50 | $1,859.63 | $3,443.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,909.03 / $1,909.03 / $2,172.29
| Professional | | $1,909.03 | $1,909.03 | $2,172.29 |
- 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
- $1,390.53 / $2,400.83 / $5,044.77
| Professional | | $1,390.53 | $2,400.83 | $5,044.77 |