- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,081.04 / $2,081.04 / $6,575.00
| Facility | | $2,081.04 | $2,081.04 | $6,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,038.80 / $2,099.73 / $3,318.77
| Professional | | $2,038.80 | $2,099.73 | $3,318.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,362.90 / $17,452.75
| Facility | | $4,184.29 | $9,362.90 | $17,452.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,662.68 / $5,875.41 / $7,412.82
| Professional | | $3,662.68 | $5,875.41 | $7,412.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,015.62 / $7,116.44 / $17,119.57
| Facility | | $5,015.62 | $7,116.44 | $17,119.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,763.62 / $5,995.36 / $8,904.03
| Professional | | $3,763.62 | $5,995.36 | $8,904.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,559.66 / $6,506.14 / $13,479.98
| Facility | | $4,559.66 | $6,506.14 | $13,479.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,407.46 / $5,360.26 / $8,165.52
| Professional | | $3,407.46 | $5,360.26 | $8,165.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.48 / $3,541.54 / $5,837.91
| Facility | | $2,160.48 | $3,541.54 | $5,837.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.16 / $3,967.14 / $8,454.46
| Professional | | $2,293.16 | $3,967.14 | $8,454.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.16 / $3,708.04 / $8,126.25
| Professional | | $2,293.16 | $3,708.04 | $8,126.25 |