- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,053.32 / $6,607.00 / $10,492.00
| Facility | | $2,053.32 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,777.09 / $2,053.32 / $3,046.49
| Professional | | $1,777.09 | $2,053.32 | $3,046.49 |
- 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
- $1,201.81 / $2,819.26 / $3,226.48
| Professional | | $1,201.81 | $2,819.26 | $3,226.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.67 / $2,059.79 / $3,247.43
| Professional | | $1,433.67 | $2,059.79 | $3,247.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.00 / $1,928.00 / $2,038.22
| Professional | | $1,928.00 | $1,928.00 | $2,038.22 |
- 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
- $1,305.35 / $1,924.40 / $3,927.68
| Professional | | $1,305.35 | $1,924.40 | $3,927.68 |