- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.23 / $1,264.23 / $6,781.00
| Facility | | $1,264.23 | $1,264.23 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,235.64 / $1,275.72 / $2,006.93
| Professional | | $1,235.64 | $1,275.72 | $2,006.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,578.25 / $11,017.98 / $21,650.55
| Facility | | $5,578.25 | $11,017.98 | $21,650.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,219.67 / $3,559.27 / $4,490.63
| Professional | | $2,219.67 | $3,559.27 | $4,490.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.16 / $4,333.41 / $10,424.60
| Facility | | $3,054.16 | $4,333.41 | $10,424.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,292.21 / $3,651.43 / $5,422.93
| Professional | | $2,292.21 | $3,651.43 | $5,422.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,776.51 / $3,961.78 / $8,208.35
| Facility | | $2,776.51 | $3,961.78 | $8,208.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,075.29 / $3,264.62 / $4,973.14
| Professional | | $2,075.29 | $3,264.62 | $4,973.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.11 / $2,152.12 / $5,331.00
| Facility | | $1,288.11 | $2,152.12 | $5,331.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,376.49 / $2,386.89 / $5,093.60
| Professional | | $1,376.49 | $2,386.89 | $5,093.60 |
- 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
- $1,376.49 / $2,386.89 / $4,877.85
| Professional | | $1,376.49 | $2,386.89 | $4,877.85 |