- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,030.51 / $6,607.00 / $10,492.00
| Facility | | $4,030.51 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,099.56 / $4,030.51 / $7,042.48
| Professional | | $3,099.56 | $4,030.51 | $7,042.48 |
- 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
- $2,593.56 / $5,289.74 / $6,276.03
| Professional | | $2,593.56 | $5,289.74 | $6,276.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,086.71 / $3,962.30 / $7,344.36
| Professional | | $3,086.71 | $3,962.30 | $7,344.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,771.78 / $4,398.95 / $4,398.95
| Professional | | $3,771.78 | $4,398.95 | $4,398.95 |
- 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
- $2,668.47 / $4,052.12 / $8,138.96
| Professional | | $2,668.47 | $4,052.12 | $8,138.96 |