- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,721.53 / $2,721.53 / $6,781.00
| Facility | | $2,721.53 | $2,721.53 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,673.00 / $2,772.85 / $4,368.52
| Professional | | $2,673.00 | $2,772.85 | $4,368.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,155.82 / $34,613.83 / $66,228.75
| Facility | | $13,155.82 | $34,613.83 | $66,228.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,859.03 / $7,804.74 / $9,847.00
| Professional | | $4,859.03 | $7,804.74 | $9,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,575.53 / $9,329.73 / $22,443.93
| Facility | | $6,575.53 | $9,329.73 | $22,443.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,929.74 / $7,852.96 / $11,662.86
| Professional | | $4,929.74 | $7,852.96 | $11,662.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,977.76 / $8,529.61 / $17,672.39
| Facility | | $5,977.76 | $8,529.61 | $17,672.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,463.22 / $7,021.08 / $10,695.52
| Professional | | $4,463.22 | $7,021.08 | $10,695.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,826.36 / $4,599.39 / $7,709.26
| Facility | | $2,826.36 | $4,599.39 | $7,709.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,040.69 / $5,470.24 / $11,170.86
| Professional | | $3,040.69 | $5,470.24 | $11,170.86 |
- 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
- $3,040.69 / $5,607.00 / $11,075.71
| Professional | | $3,040.69 | $5,607.00 | $11,075.71 |