- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.16 / $1,015.16 / $6,575.00
| Facility | | $1,015.16 | $1,015.16 | $6,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.82 / $1,032.96 / $1,612.61
| Professional | | $991.82 | $1,032.96 | $1,612.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,728.85 / $13,126.55 / $25,424.06
| Facility | | $4,728.85 | $13,126.55 | $25,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.27 / $2,897.28 / $3,780.52
| Professional | | $1,808.27 | $2,897.28 | $3,780.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,464.04 / $3,496.11 / $8,410.37
| Facility | | $2,464.04 | $3,496.11 | $8,410.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,848.03 / $2,943.86 / $4,372.09
| Professional | | $1,848.03 | $2,943.86 | $4,372.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,240.03 / $3,196.28 / $6,622.34
| Facility | | $2,240.03 | $3,196.28 | $6,622.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,673.15 / $2,632.01 / $4,009.46
| Professional | | $1,673.15 | $2,632.01 | $4,009.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.04 / $1,767.66 / $5,772.84
| Facility | | $1,051.04 | $1,767.66 | $5,772.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.53 / $1,980.28 / $4,050.47
| Professional | | $1,102.53 | $1,980.28 | $4,050.47 |
- 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
- $1,102.53 / $1,976.62 / $4,012.31
| Professional | | $1,102.53 | $1,976.62 | $4,012.31 |