- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.03 / $2,165.07 / $4,846.00
| Facility | | $2,070.03 | $2,165.07 | $4,846.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,880.67 / $2,165.07 / $2,858.61
| Professional | | $1,880.67 | $2,165.07 | $2,858.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $24,214.00 / $45,778.00
| Facility | | $2,575.00 | $24,214.00 | $45,778.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,998.82 / $3,044.30 / $4,201.13
| Professional | | $1,998.82 | $3,044.30 | $4,201.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,716.61 / $2,187.84 / $2,524.42
| Facility | | $1,716.61 | $2,187.84 | $2,524.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,767.10 / $1,935.39 / $2,524.42
| Professional | | $1,767.10 | $1,935.39 | $2,524.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,898.27 / $2,887.89 / $6,668.41
| Professional | | $1,898.27 | $2,887.89 | $6,668.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $5,242.00 / $10,843.00
| Facility | | $1,403.00 | $5,242.00 | $10,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.40 / $2,433.34 / $4,646.07
| Professional | | $1,828.40 | $2,433.34 | $4,646.07 |