- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.00 / $4,231.18 / $8,561.00
| Facility | | $2,005.00 | $4,231.18 | $8,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,830.74 / $2,143.84 / $3,334.12
| Professional | | $1,830.74 | $2,143.84 | $3,334.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,068.50 / $10,449.50 / $21,886.55
| Facility | | $5,068.50 | $10,449.50 | $21,886.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,005.32 / $2,739.40 / $4,105.75
| Professional | | $2,005.32 | $2,739.40 | $4,105.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,382.40
| Facility | | $895.00 | $950.00 | $2,382.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,090.31 / $2,973.56 / $4,647.02
| Professional | | $2,090.31 | $2,973.56 | $4,647.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,900.20 / $2,648.67 / $4,655.92
| Professional | | $1,900.20 | $2,648.67 | $4,655.92 |