- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,724.88 / $6,607.00 / $10,492.00
| Facility | | $2,724.88 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,817.67 / $2,724.88 / $4,309.10
| Professional | | $1,817.67 | $2,724.88 | $4,309.10 |
- 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
- $1,627.82 / $3,236.02 / $3,839.39
| Professional | | $1,627.82 | $3,236.02 | $3,839.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,929.75 / $2,326.79 / $4,609.78
| Professional | | $1,929.75 | $2,326.79 | $4,609.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,208.40 / $2,762.47 / $2,762.47
| Professional | | $2,208.40 | $2,762.47 | $2,762.47 |
- 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
- $1,658.32 / $2,521.29 / $5,064.18
| Professional | | $1,658.32 | $2,521.29 | $5,064.18 |