- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.98 / $6,607.00 / $10,492.00
| Facility | | $2,468.98 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.44 / $2,468.98 / $3,691.97
| Professional | | $2,154.44 | $2,468.98 | $3,691.97 |
- 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
- $1,454.76 / $3,418.50 / $3,912.28
| Professional | | $1,454.76 | $3,418.50 | $3,912.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.01 / $2,493.71 / $3,931.87
| Professional | | $1,738.01 | $2,493.71 | $3,931.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.98 / $2,335.98 / $2,457.28
| Professional | | $2,335.98 | $2,335.98 | $2,457.28 |
- 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
- $1,469.64 / $2,410.63 / $4,750.41
| Professional | | $1,469.64 | $2,410.63 | $4,750.41 |