- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,031.45 / $6,607.00 / $10,492.00
| Facility | | $4,031.45 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,813.75 / $4,031.45 / $6,655.09
| Professional | | $2,813.75 | $4,031.45 | $6,655.09 |
- 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
- $2,514.13 / $4,979.56 / $5,908.02
| Professional | | $2,514.13 | $4,979.56 | $5,908.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.73 / $3,519.04 / $6,946.87
| Professional | | $3,090.73 | $3,519.04 | $6,946.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,455.20 / $4,306.21 / $4,306.21
| Professional | | $3,455.20 | $4,306.21 | $4,306.21 |
- 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
- $2,556.15 / $3,941.84 / $7,917.46
| Professional | | $2,556.15 | $3,941.84 | $7,917.46 |