- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.60 / $4,470.00 / $12,154.00
| Facility | | $2,251.60 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.03 / $2,591.46 / $2,711.97
| Professional | | $2,100.03 | $2,591.46 | $2,711.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,212.79 / $2,747.93 / $4,480.14
| Professional | | $2,212.79 | $2,747.93 | $4,480.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.94 / $3,085.09 / $5,761.37
| Professional | | $2,028.94 | $3,085.09 | $5,761.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,938.87 / $11,043.00
| Facility | | $55.00 | $2,938.87 | $11,043.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,279.42 / $4,240.50 / $24,546.00
| Professional | | $2,279.42 | $4,240.50 | $24,546.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,279.42 / $3,515.91 / $6,712.31
| Professional | | $2,279.42 | $3,515.91 | $6,712.31 |