- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,347.35 / $10,900.00 / $14,552.94
| Facility | | $7,347.35 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,494.75 / $2,749.17 / $13,432.38
| Professional | | $2,494.75 | $2,749.17 | $13,432.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,465.07 / $3,836.27 / $8,599.73
| Professional | | $2,465.07 | $3,836.27 | $8,599.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,527.94 / $13,432.38 / $18,805.33
| Facility | | $2,527.94 | $13,432.38 | $18,805.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,221.05 / $9,346.20 / $17,253.34
| Professional | | $6,221.05 | $9,346.20 | $17,253.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,729.30 / $11,899.20 / $18,982.48
| Professional | | $6,729.30 | $11,899.20 | $18,982.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,527.94 / $13,432.38 / $18,805.33
| Facility | | $2,527.94 | $13,432.38 | $18,805.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,043.42 / $9,061.20 / $16,526.53
| Professional | | $3,043.42 | $9,061.20 | $16,526.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,411.06 / $6,879.78 / $18,976.77
| Professional | | $3,411.06 | $6,879.78 | $18,976.77 |