- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,734.96 / $9,813.00 / $14,552.94
| Facility | | $2,734.96 | $9,813.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.80 / $1,040.73 / $5,000.06
| Professional | | $961.80 | $1,040.73 | $5,000.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.30 / $1,538.62 / $3,115.21
| Professional | | $933.30 | $1,538.62 | $3,115.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.84 / $5,000.06 / $7,000.08
| Facility | | $972.84 | $5,000.06 | $7,000.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,414.67 / $3,444.15 / $6,318.79
| Professional | | $2,414.67 | $3,444.15 | $6,318.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,485.12 / $4,410.00 / $7,367.96
| Professional | | $2,485.12 | $4,410.00 | $7,367.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.84 / $5,000.06 / $7,000.08
| Facility | | $972.84 | $5,000.06 | $7,000.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.00 / $3,547.20 / $6,322.80
| Professional | | $1,176.00 | $3,547.20 | $6,322.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,163.06 / $2,532.17 / $7,476.54
| Professional | | $2,163.06 | $2,532.17 | $7,476.54 |