- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,280.32 / $5,306.40 / $14,364.00
| Facility | | $3,280.32 | $5,306.40 | $14,364.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,394.00 / $2,700.00 / $3,060.00
| Professional | | $2,394.00 | $2,700.00 | $3,060.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.82 / $2,965.31 / $4,697.46
| Facility | | $780.82 | $2,965.31 | $4,697.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,740.02 / $2,530.94 / $12,259.26
| Professional | | $1,740.02 | $2,530.94 | $12,259.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.96 / $5,616.00 / $10,062.00
| Facility | | $2,090.96 | $5,616.00 | $10,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $3,600.00 / $6,497.45
| Facility | | $2,412.00 | $3,600.00 | $6,497.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.00 / $1,512.00 / $18,000.00
| Professional | | $1,512.00 | $1,512.00 | $18,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.00 / $1,512.00 / $2,160.00
| Professional | | $1,512.00 | $1,512.00 | $2,160.00 |