- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,568.41 / $1,568.41 / $9,768.00
| Facility | | $1,568.41 | $1,568.41 | $9,768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,568.41 / $1,568.41 / $2,195.01
| Professional | | $1,568.41 | $1,568.41 | $2,195.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,227.10 / $11,098.97 / $22,113.88
| Facility | | $6,227.10 | $11,098.97 | $22,113.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,514.08 / $3,888.84 / $5,456.51
| Professional | | $2,514.08 | $3,888.84 | $5,456.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,643.63 / $5,167.13 / $12,430.22
| Facility | | $3,643.63 | $5,167.13 | $12,430.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,949.65 / $4,981.76 / $7,076.62
| Professional | | $2,949.65 | $4,981.76 | $7,076.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,962.01 / $4,723.99 / $9,787.58
| Facility | | $2,962.01 | $4,723.99 | $9,787.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,596.89 / $4,444.06 / $5,889.32
| Professional | | $2,596.89 | $4,444.06 | $5,889.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.97 / $3,017.37 / $10,878.00
| Facility | | $2,034.97 | $3,017.37 | $10,878.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,954.01 / $3,807.03 / $8,186.43
| Professional | | $1,954.01 | $3,807.03 | $8,186.43 |
- 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
- $1,983.84 / $3,621.99 / $6,147.60
| Professional | | $1,983.84 | $3,621.99 | $6,147.60 |