- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,238.40 / $5,118.26 / $8,246.09
| Facility | | $3,238.40 | $5,118.26 | $8,246.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $2,590.71 / $5,781.74
| Professional | | $477.00 | $2,590.71 | $5,781.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,696.52 / $4,423.18 / $5,592.17
| Facility | | $3,696.52 | $4,423.18 | $5,592.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,159.42 / $4,802.32
| Professional | | $3,159.42 | $3,159.42 | $4,802.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,008.66 / $7,722.50 / $14,543.76
| Facility | | $4,008.66 | $7,722.50 | $14,543.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,791.30 / $3,848.09 / $4,610.43
| Professional | | $3,791.30 | $3,848.09 | $4,610.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.42 / $4,423.18 / $6,634.78
| Professional | | $3,159.42 | $4,423.18 | $6,634.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,296.81 / $4,296.81 / $4,739.13
| Professional | | $4,296.81 | $4,296.81 | $4,739.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $3,159.42
| Professional | | $1,326.96 | $1,895.65 | $3,159.42 |