- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,997.13 / $4,248.00 / $8,238.00
| Facility | | $1,997.13 | $4,248.00 | $8,238.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,900.93 / $2,208.90 / $3,508.99
| Professional | | $1,900.93 | $2,208.90 | $3,508.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,329.50 / $16,401.00 / $29,216.95
| Facility | | $8,329.50 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.12 / $2,697.01 / $4,256.37
| Professional | | $2,102.12 | $2,697.01 | $4,256.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,434.15 / $2,434.15 / $3,400.87
| Facility | | $2,434.15 | $2,434.15 | $3,400.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,150.94 / $3,150.55 / $5,060.13
| Professional | | $2,150.94 | $3,150.55 | $5,060.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,040.06 / $2,882.56 / $5,305.76
| Professional | | $2,040.06 | $2,882.56 | $5,305.76 |