- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,051.57 / $5,695.00 / $10,871.00
| Facility | | $3,051.57 | $5,695.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,517.10 / $3,063.07 / $4,841.13
| Professional | | $2,517.10 | $3,063.07 | $4,841.13 |
- 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
- $2,985.92 / $4,593.83 / $10,896.46
| Professional | | $2,985.92 | $4,593.83 | $10,896.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,910.25 / $4,002.36 / $5,161.14
| Professional | | $2,910.25 | $4,002.36 | $5,161.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,683.14 / $3,674.00 / $7,832.71
| Professional | | $2,683.14 | $3,674.00 | $7,832.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,066.00 / $12,315.00 / $27,214.00
| Facility | | $6,066.00 | $12,315.00 | $27,214.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,297.90 / $4,114.25 / $8,541.07
| Professional | | $2,297.90 | $4,114.25 | $8,541.07 |