- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,667.57 / $9,774.00 / $14,552.94
| Facility | | $2,667.57 | $9,774.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.25 / $940.13 / $4,524.29
| Professional | | $804.25 | $940.13 | $4,524.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,281.44 / $3,059.37 / $3,985.20
| Professional | | $2,281.44 | $3,059.37 | $3,985.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.01 / $4,524.29 / $6,334.01
| Facility | | $883.01 | $4,524.29 | $6,334.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,297.40 / $2,756.88 / $5,596.77
| Professional | | $2,297.40 | $2,756.88 | $5,596.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,347.50 / $4,567.89 / $5,628.00
| Professional | | $3,347.50 | $4,567.89 | $5,628.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.01 / $4,524.29 / $6,334.01
| Facility | | $883.01 | $4,524.29 | $6,334.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.71 / $4,457.25 / $5,922.40
| Professional | | $1,383.71 | $4,457.25 | $5,922.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,447.50 / $4,283.13 / $5,384.50
| Professional | | $2,447.50 | $4,283.13 | $5,384.50 |