- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.59 / $1,243.59 / $6,781.00
| Facility | | $1,243.59 | $1,243.59 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.08 / $1,243.59 / $1,983.24
| Professional | | $1,166.08 | $1,243.59 | $1,983.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,538.60
| Facility | | $2,088.76 | $5,302.71 | $10,538.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,243.61 / $3,594.79 / $4,690.67
| Professional | | $2,243.61 | $3,594.79 | $4,690.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,048.27 / $4,325.05 / $10,404.49
| Facility | | $3,048.27 | $4,325.05 | $10,404.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,287.83 / $3,644.45 / $5,412.57
| Professional | | $2,287.83 | $3,644.45 | $5,412.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,771.15 / $3,954.13 / $8,192.51
| Facility | | $2,771.15 | $3,954.13 | $8,192.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,071.32 / $3,258.39 / $4,963.64
| Professional | | $2,071.32 | $3,258.39 | $4,963.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.21 / $2,129.26 / $3,658.36
| Facility | | $1,301.21 | $2,129.26 | $3,658.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.14 / $2,478.30 / $5,044.64
| Professional | | $1,373.14 | $2,478.30 | $5,044.64 |
- 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
- $1,373.14 / $2,447.69 / $4,997.10
| Professional | | $1,373.14 | $2,447.69 | $4,997.10 |