- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.02 / $6,607.00 / $10,492.00
| Facility | | $2,050.02 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.18 / $2,050.02 / $3,353.06
| Professional | | $1,462.18 | $2,050.02 | $3,353.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,329.50 / $17,206.00 / $26,880.01
| Facility | | $8,329.50 | $17,206.00 | $26,880.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.35 / $2,515.51 / $2,984.54
| Professional | | $1,254.35 | $2,515.51 | $2,984.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.95 / $1,852.04 / $3,547.18
| Professional | | $1,481.95 | $1,852.04 | $3,547.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,785.04 / $2,132.46 / $2,132.46
| Professional | | $1,785.04 | $2,132.46 | $2,132.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,414.00 / $5,950.00 / $9,338.00
| Facility | | $3,414.00 | $5,950.00 | $9,338.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.08 / $1,724.02 / $3,888.39
| Professional | | $1,271.08 | $1,724.02 | $3,888.39 |