- 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
- $580.51 / $3,025.63 / $3,269.87
| Professional | | $580.51 | $3,025.63 | $3,269.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,520.67 / $2,031.06 / $2,692.71
| Professional | | $1,520.67 | $2,031.06 | $2,692.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.73 / $3,025.63 / $4,235.88
| Facility | | $595.73 | $3,025.63 | $4,235.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.25 / $1,865.10 / $3,786.34
| Professional | | $1,554.25 | $1,865.10 | $3,786.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,241.25 / $3,092.56 / $3,806.00
| Professional | | $2,241.25 | $3,092.56 | $3,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.73 / $3,025.63 / $4,235.88
| Facility | | $595.73 | $3,025.63 | $4,235.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.74 / $3,056.60 / $3,960.00
| Professional | | $926.74 | $3,056.60 | $3,960.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,624.84 / $2,451.23 / $3,574.65
| Professional | | $1,624.84 | $2,451.23 | $3,574.65 |