- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $2,607.56 / $4,846.00
| Facility | | $2,318.00 | $2,607.56 | $4,846.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,256.94 / $2,607.56 / $3,364.59
| Professional | | $2,256.94 | $2,607.56 | $3,364.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $10,577.42 / $18,643.75
| Facility | | $5,091.00 | $10,577.42 | $18,643.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,608.32 / $2,049.50 / $2,828.31
| Professional | | $1,608.32 | $2,049.50 | $2,828.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.55 / $2,642.76 / $3,049.34
| Facility | | $2,073.55 | $2,642.76 | $3,049.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,134.53 / $2,439.46 / $3,049.34
| Professional | | $2,134.53 | $2,439.46 | $3,049.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.32 / $2,586.82 / $4,828.02
| Professional | | $1,772.32 | $2,586.82 | $4,828.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $5,242.00 / $10,843.00
| Facility | | $1,403.00 | $5,242.00 | $10,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,661.16 / $2,781.00 / $4,171.53
| Professional | | $1,661.16 | $2,781.00 | $4,171.53 |