- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,174.00 / $8,419.00 / $26,240.00
| Facility | | $4,174.00 | $8,419.00 | $26,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,711.76 / $9,871.43 / $9,871.43
| Professional | | $3,711.76 | $9,871.43 | $9,871.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.86 / $4,859.57 / $13,509.20
| Professional | | $1,059.86 | $4,859.57 | $13,509.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,999.06 / $12,001.50 / $26,025.12
| Facility | | $10,999.06 | $12,001.50 | $26,025.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,071.24 / $3,938.42 / $7,344.19
| Professional | | $3,071.24 | $3,938.42 | $7,344.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.00 / $7,273.00 / $10,536.00
| Facility | | $1,846.00 | $7,273.00 | $10,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,712.96 / $4,026.49 / $8,514.20
| Professional | | $2,712.96 | $4,026.49 | $8,514.20 |