- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,869.20 / $6,607.00 / $10,492.00
| Facility | | $3,869.20 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,139.15 / $3,869.20 / $5,752.30
| Professional | | $2,139.15 | $3,869.20 | $5,752.30 |
- 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
- $2,445.91 / $4,958.68 / $5,883.26
| Professional | | $2,445.91 | $4,958.68 | $5,883.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,907.08 / $3,807.68 / $6,644.83
| Professional | | $2,907.08 | $3,807.68 | $6,644.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,531.02 / $4,150.20 / $4,150.20
| Professional | | $3,531.02 | $4,150.20 | $4,150.20 |
- 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
- $2,509.67 / $3,531.48 / $7,655.23
| Professional | | $2,509.67 | $3,531.48 | $7,655.23 |