- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,741.00 / $10,480.00 / $13,413.92
| Facility | | $3,741.00 | $10,480.00 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.14 / $2,025.51 / $2,220.98
| Professional | | $366.14 | $2,025.51 | $2,220.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.89 / $1,406.89 / $1,406.89
| Professional | | $1,406.89 | $1,406.89 | $1,406.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.23 / $2,025.51 / $2,896.48
| Facility | | $524.23 | $2,025.51 | $2,896.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.08 / $2,732.10 / $3,466.00
| Professional | | $1,052.08 | $2,732.10 | $3,466.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.25 / $1,886.45 / $2,523.40
| Professional | | $1,626.25 | $1,886.45 | $2,523.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.23 / $2,025.51 / $2,896.48
| Facility | | $524.23 | $2,025.51 | $2,896.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.33 / $1,828.50 / $2,602.41
| Professional | | $554.33 | $1,828.50 | $2,602.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.50 / $1,125.52 / $2,473.65
| Professional | | $1,075.50 | $1,125.52 | $2,473.65 |