- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.16 / $6,607.00 / $10,492.00
| Facility | | $2,485.16 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.94 / $2,485.16 / $4,426.82
| Professional | | $1,418.94 | $2,485.16 | $4,426.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,927.44 / $14,057.22 / $19,128.36
| Facility | | $5,927.44 | $14,057.22 | $19,128.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.62 / $2,865.34 / $3,399.59
| Professional | | $1,374.62 | $2,865.34 | $3,399.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,724.29 / $2,176.27 / $4,354.99
| Professional | | $1,724.29 | $2,176.27 | $4,354.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,919.32 / $2,276.21 / $2,276.21
| Professional | | $1,919.32 | $2,276.21 | $2,276.21 |
- 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
- $1,443.58 / $2,482.44 / $4,408.77
| Professional | | $1,443.58 | $2,482.44 | $4,408.77 |