- 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
- $535.26 / $627.92 / $3,049.76
| Professional | | $535.26 | $627.92 | $3,049.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,525.67 / $2,030.96 / $2,722.36
| Professional | | $1,525.67 | $2,030.96 | $2,722.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.37 / $3,049.76 / $4,269.66
| Facility | | $600.37 | $3,049.76 | $4,269.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,568.80 / $1,882.56 / $3,821.80
| Professional | | $1,568.80 | $1,882.56 | $3,821.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,247.50 / $3,097.72 / $3,832.00
| Professional | | $2,247.50 | $3,097.72 | $3,832.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.37 / $3,049.76 / $4,269.66
| Facility | | $600.37 | $3,049.76 | $4,269.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.66 / $3,061.70 / $3,960.00
| Professional | | $933.66 | $3,061.70 | $3,960.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,624.76 / $2,843.33 / $3,574.47
| Professional | | $1,624.76 | $2,843.33 | $3,574.47 |