- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,178.83 / $2,178.83 / $6,781.00
| Facility | | $2,178.83 | $2,178.83 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.22 / $2,190.62 / $3,470.49
| Professional | | $2,001.22 | $2,190.62 | $3,470.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,610.82 / $13,180.74 / $23,682.56
| Facility | | $7,610.82 | $13,180.74 | $23,682.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,819.04 / $6,155.43 / $7,802.17
| Professional | | $3,819.04 | $6,155.43 | $7,802.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,247.13 / $7,444.91 / $17,909.75
| Facility | | $5,247.13 | $7,444.91 | $17,909.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,928.78 / $6,258.45 / $9,294.76
| Professional | | $3,928.78 | $6,258.45 | $9,294.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,770.10 / $6,806.44 / $14,102.16
| Facility | | $4,770.10 | $6,806.44 | $14,102.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,556.99 / $5,597.39 / $8,523.84
| Professional | | $3,556.99 | $5,597.39 | $8,523.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,229.53 / $3,695.13 / $6,500.38
| Facility | | $2,229.53 | $3,695.13 | $6,500.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,393.52 / $4,245.66 / $8,832.03
| Professional | | $2,393.52 | $4,245.66 | $8,832.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $6,787.00 / $11,165.00
| Facility | | $3,940.00 | $6,787.00 | $11,165.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,393.52 / $3,950.48 / $8,379.61
| Professional | | $2,393.52 | $3,950.48 | $8,379.61 |