- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,501.68 / $1,501.68 / $6,781.00
| Facility | | $1,501.68 | $1,501.68 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.64 / $1,530.82 / $2,396.73
| Professional | | $1,470.64 | $1,530.82 | $2,396.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $8,373.01 / $13,357.68
| Facility | | $4,206.67 | $8,373.01 | $13,357.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,656.72 / $4,288.24 / $5,611.77
| Professional | | $2,656.72 | $4,288.24 | $5,611.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,638.39 / $5,162.35 / $12,418.73
| Facility | | $3,638.39 | $5,162.35 | $12,418.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,730.75 / $4,350.02 / $6,460.45
| Professional | | $2,730.75 | $4,350.02 | $6,460.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,307.63 / $4,719.62 / $9,778.53
| Facility | | $3,307.63 | $4,719.62 | $9,778.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,472.34 / $3,889.22 / $5,924.61
| Professional | | $2,472.34 | $3,889.22 | $5,924.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.92 / $2,537.84 / $4,417.56
| Facility | | $1,339.92 | $2,537.84 | $4,417.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,654.54 / $2,932.66 / $6,078.43
| Professional | | $1,654.54 | $2,932.66 | $6,078.43 |
- 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
- $1,606.35 / $2,885.62 / $6,021.16
| Professional | | $1,606.35 | $2,885.62 | $6,021.16 |