- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,611.92 / $6,607.00 / $10,492.00
| Facility | | $2,611.92 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,978.36 / $2,611.92 / $4,652.07
| Professional | | $1,978.36 | $2,611.92 | $4,652.07 |
- 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
- $1,741.40 / $3,493.35 / $4,144.68
| Professional | | $1,741.40 | $3,493.35 | $4,144.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,066.29 / $2,520.81 / $4,657.32
| Professional | | $2,066.29 | $2,520.81 | $4,657.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.05 / $2,955.45 / $2,955.45
| Professional | | $2,405.05 | $2,955.45 | $2,955.45 |
- 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
- $1,618.67 / $2,407.01 / $5,428.81
| Professional | | $1,618.67 | $2,407.01 | $5,428.81 |