- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,236.00 / $9,774.00 / $14,552.94
| Facility | | $2,236.00 | $9,774.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.13 / $2,692.07 / $2,692.07
| Professional | | $518.13 | $2,692.07 | $2,692.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.47 / $1,796.74 / $2,406.86
| Professional | | $1,351.47 | $1,796.74 | $2,406.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.96 / $2,692.07 / $3,768.90
| Facility | | $530.96 | $2,692.07 | $3,768.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.85 / $1,664.22 / $3,378.55
| Professional | | $1,386.85 | $1,664.22 | $3,378.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,987.50 / $2,713.20 / $3,381.40
| Professional | | $1,987.50 | $2,713.20 | $3,381.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.96 / $2,692.07 / $3,768.90
| Facility | | $530.96 | $2,692.07 | $3,768.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.33 / $2,682.75 / $3,381.40
| Professional | | $824.33 | $2,682.75 | $3,381.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.38 / $2,515.42 / $3,162.24
| Professional | | $1,437.38 | $2,515.42 | $3,162.24 |