- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,609.09 / $6,607.00 / $10,492.00
| Facility | | $2,609.09 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.01 / $2,609.09 / $4,191.63
| Professional | | $1,832.01 | $2,609.09 | $4,191.63 |
- 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
- $1,569.03 / $3,147.00 / $3,733.77
| Professional | | $1,569.03 | $3,147.00 | $3,733.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,859.39 / $2,393.16 / $4,446.37
| Professional | | $1,859.39 | $2,393.16 | $4,446.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,231.67 / $2,661.82 / $2,661.82
| Professional | | $2,231.67 | $2,661.82 | $2,661.82 |
- 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
- $1,563.51 / $2,430.14 / $4,881.10
| Professional | | $1,563.51 | $2,430.14 | $4,881.10 |