- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,228.13 / $10,900.00 / $14,552.94
| Facility | | $5,228.13 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,429.48 / $8,429.48 / $10,701.30
| Professional | | $8,429.48 | $8,429.48 | $10,701.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,030.74 / $6,030.74 / $6,030.74
| Professional | | $6,030.74 | $6,030.74 | $6,030.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.55 / $8,429.48 / $12,054.16
| Facility | | $2,187.55 | $8,429.48 | $12,054.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,452.50 / $11,562.60 / $14,420.58
| Professional | | $4,452.50 | $11,562.60 | $14,420.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,882.50 / $7,983.70 / $10,620.00
| Professional | | $6,882.50 | $7,983.70 | $10,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.55 / $8,429.48 / $12,054.16
| Facility | | $2,187.55 | $8,429.48 | $12,054.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,273.83 / $7,939.50 / $10,675.01
| Professional | | $2,273.83 | $7,939.50 | $10,675.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,206.77 / $4,824.58 / $10,473.65
| Professional | | $2,206.77 | $4,824.58 | $10,473.65 |