- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,479.42 / $6,607.00 / $10,492.00
| Facility | | $2,479.42 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,789.93 / $2,479.42 / $3,525.74
| Professional | | $1,789.93 | $2,479.42 | $3,525.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,021.45 / $11,075.34 / $12,977.57
| Facility | | $4,021.45 | $11,075.34 | $12,977.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.36 / $2,845.86 / $3,376.48
| Professional | | $1,412.36 | $2,845.86 | $3,376.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.03 / $2,033.71 / $4,479.17
| Professional | | $1,591.03 | $2,033.71 | $4,479.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,792.86 / $2,370.69 / $2,370.69
| Professional | | $1,792.86 | $2,370.69 | $2,370.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,275.00 / $6,137.00 / $16,193.00
| Facility | | $3,275.00 | $6,137.00 | $16,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.30 / $2,356.39 / $4,324.43
| Professional | | $1,350.30 | $2,356.39 | $4,324.43 |