- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,840.00 / $9,196.00
| Facility | | $2,114.00 | $4,840.00 | $9,196.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,888.42 / $6,710.07 / $6,710.07
| Professional | | $3,888.42 | $6,710.07 | $6,710.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,645.63 / $9,897.75 / $16,290.83
| Facility | | $2,645.63 | $9,897.75 | $16,290.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.17 / $422.90 / $528.62
| Professional | | $317.17 | $422.90 | $528.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,406.20 / $14,406.20 / $14,406.20
| Facility | | $14,406.20 | $14,406.20 | $14,406.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,141.25 / $5,141.25 / $5,141.25
| Professional | | $5,141.25 | $5,141.25 | $5,141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,666.10 / $7,381.08 / $10,800.00
| Facility | | $4,666.10 | $7,381.08 | $10,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |