- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,872.00 / $8,303.41 / $13,413.92
| Facility | | $1,872.00 | $8,303.41 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.51 / $1,842.51 / $2,540.44
| Professional | | $1,842.51 | $1,842.51 | $2,540.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,345.32 / $1,345.32 / $1,345.32
| Professional | | $1,345.32 | $1,345.32 | $1,345.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.36 / $1,842.51 / $2,634.79
| Facility | | $496.36 | $1,842.51 | $2,634.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.83 / $2,526.30 / $3,241.75
| Professional | | $972.83 | $2,526.30 | $3,241.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,503.75 / $1,744.35 / $2,523.40
| Professional | | $1,503.75 | $1,744.35 | $2,523.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.36 / $1,842.51 / $2,634.79
| Facility | | $496.36 | $1,842.51 | $2,634.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.40 / $1,713.00 / $2,551.12
| Professional | | $543.40 | $1,713.00 | $2,551.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.54 / $1,614.39 / $2,486.39
| Professional | | $1,009.54 | $1,614.39 | $2,486.39 |