- 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
- $467.25 / $1,580.56 / $2,680.67
| Professional | | $467.25 | $1,580.56 | $2,680.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,340.62 / $1,773.76 / $2,422.50
| Professional | | $1,340.62 | $1,773.76 | $2,422.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.08 / $2,680.67 / $3,752.94
| Facility | | $518.08 | $2,680.67 | $3,752.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.40 / $1,681.68 / $3,414.01
| Professional | | $1,401.40 | $1,681.68 | $3,414.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.50 / $2,717.75 / $3,426.00
| Professional | | $1,977.50 | $2,717.75 | $3,426.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.95 / $2,680.67 / $3,752.94
| Facility | | $534.95 | $2,680.67 | $3,752.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.64 / $2,699.60 / $3,484.80
| Professional | | $822.64 | $2,699.60 | $3,484.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,414.54 / $2,432.07 / $3,121.80
| Professional | | $1,414.54 | $2,432.07 | $3,121.80 |