- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.19 / $1,271.19 / $6,781.00
| Facility | | $1,271.19 | $1,271.19 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.74 / $1,294.93 / $2,025.19
| Professional | | $1,243.74 | $1,294.93 | $2,025.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,690.21
| Facility | | $2,088.76 | $5,302.71 | $10,690.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,259.35 / $3,635.82 / $4,744.21
| Professional | | $2,259.35 | $3,635.82 | $4,744.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,082.78 / $4,374.02 / $10,522.30
| Facility | | $3,082.78 | $4,374.02 | $10,522.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,312.85 / $3,684.32 / $5,471.77
| Professional | | $2,312.85 | $3,684.32 | $5,471.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,802.53 / $3,998.90 / $8,285.28
| Facility | | $2,802.53 | $3,998.90 | $8,285.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,093.98 / $3,294.03 / $5,017.93
| Professional | | $2,093.98 | $3,294.03 | $5,017.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.38 / $2,178.23 / $3,739.50
| Facility | | $1,315.38 | $2,178.23 | $3,739.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,392.48 / $2,520.10 / $5,115.67
| Professional | | $1,392.48 | $2,520.10 | $5,115.67 |
- 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
- $1,487.11 / $2,753.41 / $5,067.47
| Professional | | $1,487.11 | $2,753.41 | $5,067.47 |