- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,935.01 / $6,607.00 / $10,492.00
| Facility | | $3,935.01 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,776.26 / $3,935.01 / $6,321.01
| Professional | | $2,776.26 | $3,935.01 | $6,321.01 |
- 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
- $2,345.69 / $4,748.66 / $5,634.06
| Professional | | $2,345.69 | $4,748.66 | $5,634.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,788.72 / $3,640.33 / $6,645.20
| Professional | | $2,788.72 | $3,640.33 | $6,645.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,376.41 / $3,978.68 / $3,978.68
| Professional | | $3,376.41 | $3,978.68 | $3,978.68 |
- 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
- $2,406.82 / $3,654.53 / $7,542.68
| Professional | | $2,406.82 | $3,654.53 | $7,542.68 |