- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.06 / $1,247.06 / $6,575.00
| Facility | | $1,247.06 | $1,247.06 | $6,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.02 / $1,290.33 / $2,016.93
| Professional | | $1,217.02 | $1,290.33 | $2,016.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,879.41 / $22,897.69 / $46,771.99
| Facility | | $5,879.41 | $22,897.69 | $46,771.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,212.78 / $3,556.56 / $4,640.78
| Professional | | $2,212.78 | $3,556.56 | $4,640.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,033.11 / $4,303.55 / $10,352.77
| Facility | | $3,033.11 | $4,303.55 | $10,352.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,277.82 / $3,628.51 / $5,388.89
| Professional | | $2,277.82 | $3,628.51 | $5,388.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.38 / $3,934.48 / $8,151.79
| Facility | | $2,757.38 | $3,934.48 | $8,151.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.26 / $3,244.13 / $4,941.93
| Professional | | $2,062.26 | $3,244.13 | $4,941.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.73 / $2,178.87 / $5,913.00
| Facility | | $1,282.73 | $2,178.87 | $5,913.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.39 / $2,424.40 / $4,955.63
| Professional | | $1,346.39 | $2,424.40 | $4,955.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,368.00 / $8,467.00 / $12,774.00
| Facility | | $3,368.00 | $8,467.00 | $12,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.39 / $2,303.17 / $4,771.17
| Professional | | $1,346.39 | $2,303.17 | $4,771.17 |