- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.13 / $1,288.13 / $7,900.00
| Facility | | $1,288.13 | $1,288.13 | $7,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.13 / $1,288.13 / $1,789.71
| Professional | | $1,288.13 | $1,288.13 | $1,789.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,269.06 / $10,188.53 / $21,650.55
| Facility | | $5,269.06 | $10,188.53 | $21,650.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,027.27 / $3,165.92 / $4,461.51
| Professional | | $2,027.27 | $3,165.92 | $4,461.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,984.14 / $4,231.88 / $10,180.37
| Facility | | $2,984.14 | $4,231.88 | $10,180.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,393.58 / $4,077.27 / $5,742.52
| Professional | | $2,393.58 | $4,077.27 | $5,742.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,425.89 / $3,868.96 / $8,016.04
| Facility | | $2,425.89 | $3,868.96 | $8,016.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,107.32 / $3,606.25 / $4,779.05
| Professional | | $2,107.32 | $3,606.25 | $4,779.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,495.02 / $2,395.27 / $10,533.00
| Facility | | $1,495.02 | $2,395.27 | $10,533.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,536.80 / $3,050.83 / $6,560.33
| Professional | | $1,536.80 | $3,050.83 | $6,560.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.77 / $2,929.97 / $4,994.99
| Professional | | $1,590.77 | $2,929.97 | $4,994.99 |