- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,476.39 / $9,577.00 / $14,552.94
| Facility | | $1,476.39 | $9,577.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.01 / $1,853.37 / $2,774.69
| Professional | | $437.01 | $1,853.37 | $2,774.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.95 / $1,426.95 / $1,883.89
| Professional | | $1,426.95 | $1,426.95 | $1,883.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.65 / $2,406.44 / $3,369.02
| Facility | | $487.65 | $2,406.44 | $3,369.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.65 / $2,484.30 / $3,440.14
| Professional | | $956.65 | $2,484.30 | $3,440.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.60 / $2,130.30 / $3,258.00
| Professional | | $1,560.60 | $2,130.30 | $3,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.65 / $2,406.44 / $3,369.02
| Facility | | $487.65 | $2,406.44 | $3,369.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.03 / $1,943.75 / $3,258.00
| Professional | | $763.03 | $1,943.75 | $3,258.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.16 / $1,507.12 / $3,394.52
| Professional | | $1,329.16 | $1,507.12 | $3,394.52 |