- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,812.29 / $9,530.71 / $41,144.00
| Facility | | $3,812.29 | $9,530.71 | $41,144.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,812.29 / $5,682.47 / $7,193.00
| Professional | | $3,812.29 | $5,682.47 | $7,193.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,031.16 / $15,854.45 / $32,960.83
| Facility | | $7,031.16 | $15,854.45 | $32,960.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,185.77 / $7,459.31 / $15,425.95
| Professional | | $4,185.77 | $7,459.31 | $15,425.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,035.10 / $7,552.65 / $10,429.85
| Professional | | $5,035.10 | $7,552.65 | $10,429.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,711.10 / $6,950.00 / $8,702.00
| Facility | | $2,711.10 | $6,950.00 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,021.06 / $4,315.80 / $7,336.86
| Professional | | $3,021.06 | $4,315.80 | $7,336.86 |