- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.85 / $1,473.85 / $6,781.00
| Facility | | $1,473.85 | $1,473.85 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.20 / $1,502.17 / $2,351.76
| Professional | | $1,443.20 | $1,502.17 | $2,351.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $11,629.68
| Facility | | $2,088.76 | $5,302.71 | $11,629.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,623.25 / $4,207.35 / $5,505.91
| Professional | | $2,623.25 | $4,207.35 | $5,505.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,571.88 / $5,067.99 / $12,191.73
| Facility | | $3,571.88 | $5,067.99 | $12,191.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,680.70 / $4,270.30 / $6,342.05
| Professional | | $2,680.70 | $4,270.30 | $6,342.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,247.17 / $4,633.35 / $9,599.79
| Facility | | $3,247.17 | $4,633.35 | $9,599.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,427.02 / $3,817.94 / $5,816.03
| Professional | | $2,427.02 | $3,817.94 | $5,816.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,177.20 / $2,490.81 / $4,335.68
| Facility | | $1,177.20 | $2,490.81 | $4,335.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,622.57 / $2,931.08 / $5,960.97
| Professional | | $1,622.57 | $2,931.08 | $5,960.97 |
- 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
- $1,612.09 / $2,784.53 / $5,749.88
| Professional | | $1,612.09 | $2,784.53 | $5,749.88 |