- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,162.17 / $10,900.00 / $14,552.94
| Facility | | $6,162.17 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,117.06 / $2,336.75 / $11,265.63
| Professional | | $2,117.06 | $2,336.75 | $11,265.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,068.08 / $3,254.31 / $7,202.86
| Professional | | $2,068.08 | $3,254.31 | $7,202.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,145.94 / $11,265.63 / $15,771.88
| Facility | | $2,145.94 | $11,265.63 | $15,771.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,215.08 / $7,762.98 / $14,357.59
| Professional | | $5,215.08 | $7,762.98 | $14,357.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,649.28 / $10,072.00 / $15,912.91
| Professional | | $5,649.28 | $10,072.00 | $15,912.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,145.94 / $11,265.63 / $15,771.88
| Facility | | $2,145.94 | $11,265.63 | $15,771.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,539.46 / $7,689.60 / $13,973.18
| Professional | | $2,539.46 | $7,689.60 | $13,973.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,879.72 / $5,762.28 / $15,894.33
| Professional | | $2,879.72 | $5,762.28 | $15,894.33 |