- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.21 / $1,324.21 / $8,615.00
| Facility | | $1,324.21 | $1,324.21 | $8,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,324.21 / $1,324.21 / $1,843.80
| Professional | | $1,324.21 | $1,324.21 | $1,843.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $7,309.35 / $13,020.23
| Facility | | $4,184.29 | $7,309.35 | $13,020.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.25 / $3,264.85 / $4,581.72
| Professional | | $2,102.25 | $3,264.85 | $4,581.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,073.42 / $4,358.49 / $10,484.95
| Facility | | $3,073.42 | $4,358.49 | $10,484.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,476.51 / $4,202.13 / $5,941.49
| Professional | | $2,476.51 | $4,202.13 | $5,941.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,498.46 / $3,984.71 / $8,255.86
| Facility | | $2,498.46 | $3,984.71 | $8,255.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,180.34 / $3,731.20 / $4,944.64
| Professional | | $2,180.34 | $3,731.20 | $4,944.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,602.03 / $2,533.98 / $7,770.00
| Facility | | $1,602.03 | $2,533.98 | $7,770.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.62 / $3,288.04 / $7,070.41
| Professional | | $1,683.62 | $3,288.04 | $7,070.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.62 / $3,790.50 / $5,170.01
| Professional | | $1,683.62 | $3,790.50 | $5,170.01 |