- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,864.33 / $5,063.00 / $7,421.00
| Facility | | $2,864.33 | $5,063.00 | $7,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,449.92 / $2,864.33 / $5,448.67
| Professional | | $2,449.92 | $2,864.33 | $5,448.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,439.08 / $7,591.82 / $21,232.89
| Facility | | $2,439.08 | $7,591.82 | $21,232.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,602.07 / $3,898.93 / $6,155.02
| Professional | | $2,602.07 | $3,898.93 | $6,155.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,983.42 / $4,295.78 / $6,964.71
| Professional | | $2,983.42 | $4,295.78 | $6,964.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,956.25 / $3,448.96 / $24,227.00
| Professional | | $2,956.25 | $3,448.96 | $24,227.00 |
- 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
- $2,670.18 / $3,818.36 / $5,970.05
| Professional | | $2,670.18 | $3,818.36 | $5,970.05 |