- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,062.51 / $5,607.54 / $15,751.81
| Professional | | $5,062.51 | $5,607.54 | $15,751.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,130.08 / $5,506.78 / $6,883.47
| Professional | | $4,130.08 | $5,506.78 | $6,883.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,164.87 / $6,907.16 / $12,998.21
| Professional | | $5,164.87 | $6,907.16 | $12,998.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.00 / $5,809.10 / $10,555.85
| Facility | | $1,943.00 | $5,809.10 | $10,555.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,208.66 / $6,779.97 / $41,111.36
| Professional | | $5,208.66 | $6,779.97 | $41,111.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,208.66 / $6,418.83 / $11,462.45
| Professional | | $5,208.66 | $6,418.83 | $11,462.45 |