- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,253.56 / $10,900.00 / $14,552.94
| Facility | | $7,253.56 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,397.36 / $11,982.75 / $11,982.75
| Professional | | $2,397.36 | $11,982.75 | $11,982.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,201.29 / $8,357.59 / $11,017.23
| Professional | | $6,201.29 | $8,357.59 | $11,017.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,483.15 / $11,982.75 / $16,775.84
| Facility | | $2,483.15 | $11,982.75 | $16,775.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,457.18 / $7,748.61 / $15,730.45
| Professional | | $6,457.18 | $7,748.61 | $15,730.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,321.50 / $11,589.48 / $15,576.00
| Professional | | $8,321.50 | $11,589.48 | $15,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,483.15 / $11,982.75 / $16,775.84
| Facility | | $2,483.15 | $11,982.75 | $16,775.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,760.52 / $11,589.48 / $17,521.38
| Professional | | $3,760.52 | $11,589.48 | $17,521.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,686.08 / $10,086.65 / $15,210.83
| Professional | | $6,686.08 | $10,086.65 | $15,210.83 |