- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,253.27 / $5,063.00 / $6,915.00
| Facility | | $2,253.27 | $5,063.00 | $6,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,935.68 / $2,346.23 / $5,512.69
| Professional | | $1,935.68 | $2,346.23 | $5,512.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.13 / $6,105.48 / $13,137.87
| Facility | | $2,226.13 | $6,105.48 | $13,137.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,994.06 / $3,105.32 / $5,759.19
| Professional | | $1,994.06 | $3,105.32 | $5,759.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,265.77 / $3,671.67 / $5,644.58
| Professional | | $2,265.77 | $3,671.67 | $5,644.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.69 / $2,724.97 / $7,124.86
| Professional | | $2,335.69 | $2,724.97 | $7,124.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.00 / $3,629.00 / $10,000.00
| Facility | | $1,036.00 | $3,629.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,091.41 / $2,944.40 / $4,863.30
| Professional | | $2,091.41 | $2,944.40 | $4,863.30 |