- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,443.15 / $2,443.15 / $6,781.00
| Facility | | $2,443.15 | $2,443.15 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.67 / $2,488.92 / $3,918.77
| Professional | | $2,398.67 | $2,488.92 | $3,918.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $18,946.68
| Facility | | $2,088.76 | $5,302.71 | $18,946.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,359.45 / $7,001.39 / $8,900.21
| Professional | | $4,359.45 | $7,001.39 | $8,900.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,905.44 / $8,378.95 / $20,156.73
| Facility | | $5,905.44 | $8,378.95 | $20,156.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,427.39 / $7,052.72 / $10,474.37
| Professional | | $4,427.39 | $7,052.72 | $10,474.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,368.58 / $7,660.38 / $15,871.44
| Facility | | $5,368.58 | $7,660.38 | $15,871.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,008.41 / $6,305.61 / $9,605.61
| Professional | | $4,008.41 | $6,305.61 | $9,605.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.13 / $4,120.39 / $6,902.66
| Facility | | $2,084.13 | $4,120.39 | $6,902.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,724.73 / $4,893.93 / $10,010.08
| Professional | | $2,724.73 | $4,893.93 | $10,010.08 |
- 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
- $2,687.26 / $4,711.42 / $9,655.60
| Professional | | $2,687.26 | $4,711.42 | $9,655.60 |