- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.73 / $3,688.21 / $4,810.00
| Facility | | $1,651.73 | $3,688.21 | $4,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.41 / $1,651.73 / $1,651.73
| Professional | | $1,457.41 | $1,651.73 | $1,651.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,380.31 / $9,463.43 / $11,950.74
| Facility | | $7,380.31 | $9,463.43 | $11,950.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.40 / $1,148.40 / $1,750.50
| Professional | | $1,148.40 | $1,148.40 | $1,750.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.57 / $1,787.75 / $3,486.11
| Professional | | $1,554.57 | $1,787.75 | $3,486.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.08 / $4,283.76 / $9,955.61
| Facility | | $1,263.08 | $4,283.76 | $9,955.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.64 / $2,366.64 / $2,835.50
| Professional | | $2,366.64 | $2,366.64 | $2,835.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.21 / $2,331.85 / $2,875.95
| Professional | | $1,943.21 | $2,331.85 | $2,875.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,544.85 / $1,943.21 / $3,303.46
| Facility | | $1,544.85 | $1,943.21 | $3,303.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,662.00 / $3,847.56 / $4,663.70
| Professional | | $2,662.00 | $3,847.56 | $4,663.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.25 / $2,156.57 / $3,607.76
| Facility | | $1,360.25 | $2,156.57 | $3,607.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.25 / $2,209.42 / $3,607.76
| Professional | | $1,360.25 | $2,209.42 | $3,607.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $971.61 / $2,234.69
| Professional | | $816.15 | $971.61 | $2,234.69 |