- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,165.01 / $2,616.25 / $11,967.00
| Professional | | $2,165.01 | $2,616.25 | $11,967.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.25 / $6,640.00 / $10,860.55
| Facility | | $1,805.25 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,717.88 / $2,290.51 / $2,863.14
| Professional | | $1,717.88 | $2,290.51 | $2,863.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.05 / $2,618.14 / $4,059.33
| Professional | | $2,240.05 | $2,618.14 | $4,059.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.00 / $2,783.94 / $5,137.63
| Facility | | $1,778.00 | $2,783.94 | $5,137.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,207.05 / $2,602.81 / $27,409.13
| Professional | | $2,207.05 | $2,602.81 | $27,409.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,193.00 / $6,416.00
| Facility | | $1,424.00 | $3,193.00 | $6,416.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,131.98 / $2,522.79 / $4,028.27
| Professional | | $2,131.98 | $2,522.79 | $4,028.27 |