- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,916.40 / $6,607.00 / $10,492.00
| Facility | | $1,916.40 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,689.47 / $1,916.40 / $3,007.27
| Professional | | $1,689.47 | $1,916.40 | $3,007.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,755.84 / $15,054.00 / $18,574.58
| Facility | | $5,755.84 | $15,054.00 | $18,574.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.80 / $2,539.16 / $3,012.59
| Professional | | $1,308.80 | $2,539.16 | $3,012.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,545.20 / $1,982.77 / $3,615.62
| Professional | | $1,545.20 | $1,982.77 | $3,615.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,856.71 / $2,172.01 / $2,172.01
| Professional | | $1,856.71 | $2,172.01 | $2,172.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,706.00 / $11,710.00 / $21,600.00
| Facility | | $8,706.00 | $11,710.00 | $21,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,349.30 / $1,803.23 / $3,742.53
| Professional | | $1,349.30 | $1,803.23 | $3,742.53 |