- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $4,069.00 / $7,602.00
| Facility | | $2,258.00 | $4,069.00 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,209.73 / $2,713.91 / $4,368.79
| Professional | | $2,209.73 | $2,713.91 | $4,368.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $4,528.00
| Facility | | $1,275.00 | $2,326.00 | $4,528.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,209.10 / $2,961.88 / $4,895.18
| Professional | | $2,209.10 | $2,961.88 | $4,895.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,316.41 / $3,369.32 / $4,925.52
| Professional | | $2,316.41 | $3,369.32 | $4,925.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $52,435.11 / $53,785.20
| Facility | | $55.00 | $52,435.11 | $53,785.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,715.36 / $16,112.08 / $19,052.48
| Professional | | $15,715.36 | $16,112.08 | $19,052.48 |
- 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
- $2,202.48 / $3,839.36 / $6,018.53
| Professional | | $2,202.48 | $3,839.36 | $6,018.53 |