- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.67 / $3,084.00 / $4,707.00
| Facility | | $1,492.67 | $3,084.00 | $4,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.19 / $1,492.67 / $5,479.25
| Professional | | $1,051.19 | $1,492.67 | $5,479.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.10 / $1,508.36 / $2,951.58
| Professional | | $1,054.10 | $1,508.36 | $2,951.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.72 / $683.54 / $1,000.86
| Professional | | $92.72 | $683.54 | $1,000.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,433.62 / $12,630.47 / $18,406.21
| Facility | | $9,433.62 | $12,630.47 | $18,406.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,707.94 / $1,944.02 / $2,901.18
| Professional | | $1,707.94 | $1,944.02 | $2,901.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $7,693.00 / $13,847.00
| Facility | | $2,912.00 | $7,693.00 | $13,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.09 / $1,110.11 / $1,756.82
| Professional | | $911.09 | $1,110.11 | $1,756.82 |