- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,046.77 / $5,695.00 / $10,871.00
| Facility | | $3,046.77 | $5,695.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,519.31 / $3,064.18 / $4,822.47
| Professional | | $2,519.31 | $3,064.18 | $4,822.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,700.16 / $19,158.88 / $21,611.98
| Facility | | $16,700.16 | $19,158.88 | $21,611.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,986.48 / $4,594.89 / $10,879.31
| Professional | | $2,986.48 | $4,594.89 | $10,879.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,910.84 / $4,002.72 / $5,161.60
| Professional | | $2,910.84 | $4,002.72 | $5,161.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,683.77 / $3,653.39 / $7,678.88
| Professional | | $2,683.77 | $3,653.39 | $7,678.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.00 / $7,273.00 / $10,536.00
| Facility | | $1,846.00 | $7,273.00 | $10,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,438.87 / $4,094.21 / $8,508.18
| Professional | | $2,438.87 | $4,094.21 | $8,508.18 |