- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.67 / $4,396.00 / $10,300.00
| Facility | | $2,234.67 | $4,396.00 | $10,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.13 / $2,282.73 / $4,473.00
| Professional | | $1,943.13 | $2,282.73 | $4,473.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $8,455.00 / $16,907.36
| Facility | | $6,996.00 | $8,455.00 | $16,907.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,165.04 / $2,774.01 / $3,769.13
| Professional | | $2,165.04 | $2,774.01 | $3,769.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.38 / $2,471.02 / $3,604.31
| Professional | | $1,870.38 | $2,471.02 | $3,604.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.20 / $2,455.34 / $3,589.06
| Professional | | $35.20 | $2,455.34 | $3,589.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.40 / $2,050.89 / $3,076.34
| Professional | | $26.40 | $2,050.89 | $3,076.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,606.00 / $6,471.00
| Facility | | $1,061.00 | $2,606.00 | $6,471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,952.37 / $2,465.17 / $3,855.72
| Professional | | $1,952.37 | $2,465.17 | $3,855.72 |