- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,589.16 / $9,774.00 / $14,552.94
| Facility | | $2,589.16 | $9,774.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.74 / $4,391.29 / $4,391.29
| Professional | | $841.74 | $4,391.29 | $4,391.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,212.82 / $2,956.84 / $3,880.20
| Professional | | $2,212.82 | $2,956.84 | $3,880.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.48 / $4,391.29 / $6,147.81
| Facility | | $857.48 | $4,391.29 | $6,147.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,232.73 / $2,679.27 / $5,439.17
| Professional | | $2,232.73 | $2,679.27 | $5,439.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,248.75 / $4,477.16 / $5,478.00
| Professional | | $3,248.75 | $4,477.16 | $5,478.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.48 / $4,391.29 / $6,147.81
| Facility | | $857.48 | $4,391.29 | $6,147.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.81 / $4,425.10 / $5,704.60
| Professional | | $1,342.81 | $4,425.10 | $5,704.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,333.58 / $4,730.96 / $5,204.06
| Professional | | $2,333.58 | $4,730.96 | $5,204.06 |