- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.36 / $1,301.36 / $6,781.00
| Facility | | $1,301.36 | $1,301.36 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,194.04 / $1,314.45 / $2,066.19
| Professional | | $1,194.04 | $1,314.45 | $2,066.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $6,910.80 / $11,491.08
| Facility | | $3,692.86 | $6,910.80 | $11,491.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,286.94 / $3,666.20 / $4,660.50
| Professional | | $2,286.94 | $3,666.20 | $4,660.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,145.92 / $4,463.60 / $10,737.80
| Facility | | $3,145.92 | $4,463.60 | $10,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,362.27 / $3,763.04 / $5,588.70
| Professional | | $2,362.27 | $3,763.04 | $5,588.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,859.93 / $4,080.80 / $8,454.95
| Facility | | $2,859.93 | $4,080.80 | $8,454.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,138.73 / $3,364.42 / $5,125.16
| Professional | | $2,138.73 | $3,364.42 | $5,125.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.30 / $2,217.71 / $3,828.31
| Facility | | $1,326.30 | $2,217.71 | $3,828.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.85 / $2,361.78 / $4,797.47
| Professional | | $1,305.85 | $2,361.78 | $4,797.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.85 / $2,344.58 / $4,746.22
| Professional | | $1,305.85 | $2,344.58 | $4,746.22 |