- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.20 / $1,315.20 / $9,381.00
| Facility | | $1,315.20 | $1,315.20 | $9,381.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.20 / $1,532.07 / $1,900.84
| Professional | | $1,315.20 | $1,532.07 | $1,900.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $7,137.70 / $12,890.36
| Facility | | $4,142.55 | $7,137.70 | $12,890.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,961.69 / $2,996.91 / $4,510.35
| Professional | | $1,961.69 | $2,996.91 | $4,510.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,915.92 / $4,135.13 / $9,947.62
| Facility | | $2,915.92 | $4,135.13 | $9,947.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,371.82 / $3,860.14 / $5,598.16
| Professional | | $2,371.82 | $3,860.14 | $5,598.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,370.42 / $3,780.50 / $7,832.78
| Facility | | $2,370.42 | $3,780.50 | $7,832.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,982.10 / $3,181.27 / $4,735.62
| Professional | | $1,982.10 | $3,181.27 | $4,735.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.05 / $2,512.61 / $9,255.00
| Facility | | $1,636.05 | $2,512.61 | $9,255.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.58 / $2,710.86 / $5,367.82
| Professional | | $1,569.58 | $2,710.86 | $5,367.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.19 / $2,575.38 / $5,069.34
| Professional | | $1,615.19 | $2,575.38 | $5,069.34 |