- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.38 / $1,371.38 / $6,781.00
| Facility | | $1,371.38 | $1,371.38 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.64 / $1,396.90 / $2,187.42
| Professional | | $1,342.64 | $1,396.90 | $2,187.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,792.37
| Facility | | $2,088.76 | $5,302.71 | $10,792.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,439.29 / $3,925.83 / $4,976.09
| Professional | | $2,439.29 | $3,925.83 | $4,976.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,323.54 / $4,715.63 / $11,344.08
| Facility | | $3,323.54 | $4,715.63 | $11,344.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,492.40 / $3,970.33 / $5,896.55
| Professional | | $2,492.40 | $3,970.33 | $5,896.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,021.40 / $4,311.22 / $8,932.35
| Facility | | $3,021.40 | $4,311.22 | $8,932.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,256.54 / $3,549.74 / $5,407.48
| Professional | | $2,256.54 | $3,549.74 | $5,407.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.55 / $2,349.23 / $4,034.26
| Facility | | $1,417.55 | $2,349.23 | $4,034.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,505.85 / $2,718.08 / $5,532.17
| Professional | | $1,505.85 | $2,718.08 | $5,532.17 |
- 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
- $1,494.94 / $2,718.08 / $5,336.26
| Professional | | $1,494.94 | $2,718.08 | $5,336.26 |