- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,773.80 / $5,508.00 / $14,364.00
| Facility | | $2,773.80 | $5,508.00 | $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
- $1,649.15 / $6,263.00 / $9,921.46
| Facility | | $1,649.15 | $6,263.00 | $9,921.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,085.14 / $3,032.93 / $14,690.75
| Professional | | $2,085.14 | $3,032.93 | $14,690.75 |
- 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 / $6,852.90
| Facility | | $2,412.00 | $3,600.00 | $6,852.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.00 / $1,512.00 / $17,928.00
| Professional | | $1,512.00 | $1,512.00 | $17,928.00 |
- 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 |