- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,495.73 / $6,607.00 / $10,492.00
| Facility | | $2,495.73 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,794.00 / $2,495.73 / $3,629.41
| Professional | | $1,794.00 | $2,495.73 | $3,629.41 |
- 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
- $1,472.06 / $3,131.35 / $3,549.21
| Professional | | $1,472.06 | $3,131.35 | $3,549.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,633.72 / $2,386.81 / $3,954.82
| Professional | | $1,633.72 | $2,386.81 | $3,954.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,945.41 / $1,945.41 / $2,404.15
| Professional | | $1,945.41 | $1,945.41 | $2,404.15 |
- 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
- $1,544.70 / $2,665.99 / $4,646.12
| Professional | | $1,544.70 | $2,665.99 | $4,646.12 |