- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.05 / $5,695.00 / $10,871.00
| Facility | | $2,063.05 | $5,695.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,720.10 / $2,121.01 / $3,543.36
| Professional | | $1,720.10 | $2,121.01 | $3,543.36 |
- 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
- $2,052.63 / $3,165.27 / $7,576.30
| Professional | | $2,052.63 | $3,165.27 | $7,576.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,997.57 / $2,750.32 / $3,546.60
| Professional | | $1,997.57 | $2,750.32 | $3,546.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,838.12 / $2,470.59 / $5,921.84
| Professional | | $1,838.12 | $2,470.59 | $5,921.84 |
- 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
- $1,625.40 / $2,829.08 / $7,317.74
| Professional | | $1,625.40 | $2,829.08 | $7,317.74 |