- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,040.87 / $6,607.00 / $10,492.00
| Facility | | $2,040.87 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,754.21 / $2,040.87 / $3,155.88
| Professional | | $1,754.21 | $2,040.87 | $3,155.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,873.00 / $11,075.34 / $12,977.57
| Facility | | $8,873.00 | $11,075.34 | $12,977.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.52 / $2,902.18 / $3,395.46
| Professional | | $1,212.52 | $2,902.18 | $3,395.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,507.61 / $1,883.45 / $3,602.97
| Professional | | $1,507.61 | $1,883.45 | $3,602.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.64 / $1,908.64 / $2,074.02
| Professional | | $1,908.64 | $1,908.64 | $2,074.02 |
- 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
- $1,324.64 / $2,021.82 / $3,984.23
| Professional | | $1,324.64 | $2,021.82 | $3,984.23 |