- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,236.47 / $6,607.00 / $10,492.00
| Facility | | $4,236.47 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,991.60 / $4,236.47 / $6,836.35
| Professional | | $2,991.60 | $4,236.47 | $6,836.35 |
- 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
- $2,542.79 / $5,136.72 / $6,094.50
| Professional | | $2,542.79 | $5,136.72 | $6,094.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,025.54 / $3,793.30 / $6,828.53
| Professional | | $3,025.54 | $3,793.30 | $6,828.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,635.98 / $4,313.43 / $4,313.43
| Professional | | $3,635.98 | $4,313.43 | $4,313.43 |
- 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
- $2,371.48 / $3,534.64 / $7,972.09
| Professional | | $2,371.48 | $3,534.64 | $7,972.09 |