- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.26 / $6,607.00 / $10,492.00
| Facility | | $2,147.26 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.69 / $2,147.26 / $3,814.74
| Professional | | $1,461.69 | $2,147.26 | $3,814.74 |
- 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
- $1,661.08 / $2,657.06 / $3,291.18
| Professional | | $1,661.08 | $2,657.06 | $3,291.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,881.20 / $2,411.14 / $4,569.89
| Professional | | $1,881.20 | $2,411.14 | $4,569.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.56 / $2,924.05 / $2,924.05
| Professional | | $1,778.56 | $2,924.05 | $2,924.05 |
- 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
- $1,716.64 / $2,367.67 / $5,340.09
| Professional | | $1,716.64 | $2,367.67 | $5,340.09 |