- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,578.35 / $6,607.00 / $10,492.00
| Facility | | $2,578.35 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,306.85 / $2,578.35 / $4,176.29
| Professional | | $2,306.85 | $2,578.35 | $4,176.29 |
- 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
- $1,663.90 / $3,401.57 / $4,100.14
| Professional | | $1,663.90 | $3,401.57 | $4,100.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,067.03 / $2,571.92 / $4,619.63
| Professional | | $2,067.03 | $2,571.92 | $4,619.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,529.86 / $2,749.10 / $2,749.10
| Professional | | $2,529.86 | $2,749.10 | $2,749.10 |
- 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
- $1,816.39 / $2,657.86 / $8,089.91
| Professional | | $1,816.39 | $2,657.86 | $8,089.91 |