- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,188.34 / $5,045.00 / $9,218.49
| Facility | | $2,188.34 | $5,045.00 | $9,218.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,914.81 / $2,414.50 / $4,836.72
| Professional | | $1,914.81 | $2,414.50 | $4,836.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,325.76 / $8,967.21 / $21,657.35
| Facility | | $2,325.76 | $8,967.21 | $21,657.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.11 / $3,065.73 / $5,754.57
| Professional | | $2,076.11 | $3,065.73 | $5,754.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $550.00
| Facility | | $550.00 | $550.00 | $550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,127.67 / $3,594.94 / $6,528.06
| Professional | | $2,127.67 | $3,594.94 | $6,528.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,171.92 / $3,040.70 / $4,245.39
| Professional | | $2,171.92 | $3,040.70 | $4,245.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.00 / $3,629.00 / $10,000.00
| Facility | | $607.00 | $3,629.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,013.97 / $2,866.00 / $5,663.59
| Professional | | $2,013.97 | $2,866.00 | $5,663.59 |