- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,298.56 / $9,331.20 / $19,440.00
| Facility | | $6,298.56 | $9,331.20 | $19,440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.40 / $6,220.80 / $7,776.00
| Professional | | $2,480.40 | $6,220.80 | $7,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,524.84 / $8,398.08 / $26,881.63
| Facility | | $7,524.84 | $8,398.08 | $26,881.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.83 / $319.13 / $5,793.12
| Professional | | $309.83 | $319.13 | $5,793.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,939.69 / $13,040.35 / $23,326.06
| Facility | | $6,939.69 | $13,040.35 | $23,326.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,151.38 / $8,199.55 / $12,886.77
| Professional | | $4,151.38 | $8,199.55 | $12,886.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,276.80 / $4,276.80 / $7,776.00
| Facility | | $4,276.80 | $4,276.80 | $7,776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,265.92 / $4,665.60 / $10,108.79
| Professional | | $3,265.92 | $4,665.60 | $10,108.79 |