- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.02 / $1,166.02 / $7,077.00
| Facility | | $1,166.02 | $1,166.02 | $7,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.02 / $1,166.02 / $1,614.74
| Professional | | $1,166.02 | $1,166.02 | $1,614.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,736.87 / $10,188.53 / $21,650.55
| Facility | | $4,736.87 | $10,188.53 | $21,650.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.07 / $2,855.23 / $4,026.03
| Professional | | $1,828.07 | $2,855.23 | $4,026.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,701.14 / $3,830.55 / $9,214.91
| Facility | | $2,701.14 | $3,830.55 | $9,214.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,163.80 / $3,685.87 / $5,191.26
| Professional | | $2,163.80 | $3,685.87 | $5,191.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,195.83 / $3,502.04 / $7,255.84
| Facility | | $2,195.83 | $3,502.04 | $7,255.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.03 / $3,260.07 / $4,320.29
| Professional | | $1,905.03 | $3,260.07 | $4,320.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.54 / $2,121.44 / $10,533.00
| Facility | | $1,340.54 | $2,121.44 | $10,533.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.14 / $2,743.68 / $5,899.86
| Professional | | $1,379.14 | $2,743.68 | $5,899.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,331.00 / $11,165.00 / $19,570.91
| Facility | | $5,331.00 | $11,165.00 | $19,570.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.66 / $2,743.68 / $4,230.41
| Professional | | $1,434.66 | $2,743.68 | $4,230.41 |