- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,387.39 / $4,470.00 / $12,154.00
| Facility | | $2,387.39 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,218.84 / $2,763.97 / $2,876.33
| Professional | | $2,218.84 | $2,763.97 | $2,876.33 |
- 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
- $2,345.92 / $2,805.10 / $4,682.89
| Professional | | $2,345.92 | $2,805.10 | $4,682.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.76 / $3,247.52 / $5,807.44
| Professional | | $1,870.76 | $3,247.52 | $5,807.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,983.00 / $11,043.00
| Facility | | $55.00 | $2,983.00 | $11,043.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,419.81 / $4,701.97 / $16,112.08
| Professional | | $2,419.81 | $4,701.97 | $16,112.08 |
- 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
- $2,419.81 / $3,975.52 / $6,813.06
| Professional | | $2,419.81 | $3,975.52 | $6,813.06 |