- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.30 / $3,189.00 / $10,651.00
| Facility | | $2,840.30 | $3,189.00 | $10,651.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,653.57 / $2,840.30 / $3,661.40
| Professional | | $2,653.57 | $2,840.30 | $3,661.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,946.00 / $9,834.00 / $18,248.00
| Facility | | $5,946.00 | $9,834.00 | $18,248.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,734.59 / $3,588.20 / $4,949.29
| Professional | | $2,734.59 | $3,588.20 | $4,949.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,604.54 / $3,654.15 / $4,809.38
| Professional | | $2,604.54 | $3,654.15 | $4,809.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,659.64 / $3,323.15 / $4,771.70
| Facility | | $2,659.64 | $3,323.15 | $4,771.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,958.65 / $3,645.06 / $4,686.50
| Professional | | $2,958.65 | $3,645.06 | $4,686.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,506.00 / $8,565.00 / $14,156.00
| Facility | | $2,506.00 | $8,565.00 | $14,156.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,739.84 / $3,885.51 / $7,220.15
| Professional | | $2,739.84 | $3,885.51 | $7,220.15 |