- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,872.00 / $8,303.41 / $13,413.92
| Facility | | $1,872.00 | $8,303.41 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.02 / $2,140.65 / $2,528.36
| Professional | | $444.02 | $2,140.65 | $2,528.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.34 / $1,409.34 / $1,409.34
| Professional | | $1,409.34 | $1,409.34 | $1,409.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.09 / $2,140.65 / $3,061.13
| Facility | | $540.09 | $2,140.65 | $3,061.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.93 / $2,942.10 / $3,575.72
| Professional | | $1,132.93 | $2,942.10 | $3,575.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,751.25 / $2,031.45 / $2,659.80
| Professional | | $1,751.25 | $2,031.45 | $2,659.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.09 / $2,140.65 / $3,061.13
| Facility | | $540.09 | $2,140.65 | $3,061.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.33 / $1,905.00 / $2,780.81
| Professional | | $592.33 | $1,905.00 | $2,780.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.90 / $1,127.48 / $2,474.57
| Professional | | $1,075.90 | $1,127.48 | $2,474.57 |