- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,298.41 / $4,069.00 / $7,602.00
| Facility | | $2,298.41 | $4,069.00 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,298.41 / $2,834.96 / $4,606.21
| Professional | | $2,298.41 | $2,834.96 | $4,606.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $4,372.00
| Facility | | $1,275.00 | $2,326.00 | $4,372.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,305.46 / $3,086.96 / $5,153.18
| Professional | | $2,305.46 | $3,086.96 | $5,153.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.46 / $3,419.73 / $5,030.54
| Professional | | $2,405.46 | $3,419.73 | $5,030.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55,249.32 / $56,602.98
| Facility | | $55.00 | $55,249.32 | $56,602.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,209.83 / $18,938.22 / $20,043.83
| Professional | | $18,209.83 | $18,938.22 | $20,043.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,245.40 / $3,673.85 / $5,564.94
| Professional | | $2,245.40 | $3,673.85 | $5,564.94 |