- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.13 / $1,432.13 / $6,781.00
| Facility | | $1,432.13 | $1,432.13 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.36 / $1,477.17 / $2,285.12
| Professional | | $1,402.36 | $1,477.17 | $2,285.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $11,187.30
| Facility | | $2,088.76 | $5,302.71 | $11,187.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.10 / $4,091.12 / $5,200.66
| Professional | | $2,549.10 | $4,091.12 | $5,200.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,471.71 / $4,925.85 / $11,849.80
| Facility | | $3,471.71 | $4,925.85 | $11,849.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,603.76 / $4,147.72 / $6,160.00
| Professional | | $2,603.76 | $4,147.72 | $6,160.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,156.10 / $4,503.41 / $9,330.54
| Facility | | $3,156.10 | $4,503.41 | $9,330.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,357.36 / $3,708.34 / $5,649.08
| Professional | | $2,357.36 | $3,708.34 | $5,649.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.14 / $2,454.80 / $4,212.97
| Facility | | $1,481.14 | $2,454.80 | $4,212.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,576.11 / $2,841.10 / $5,790.28
| Professional | | $1,576.11 | $2,841.10 | $5,790.28 |
- 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
- $1,576.11 / $2,699.05 / $5,735.73
| Professional | | $1,576.11 | $2,699.05 | $5,735.73 |