- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,460.58 / $1,479.77 / $4,846.00
| Facility | | $1,460.58 | $1,479.77 | $4,846.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.58 / $1,479.77 / $1,909.38
| Professional | | $1,278.58 | $1,479.77 | $1,909.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.32 / $2,318.00 / $13,810.27
| Facility | | $1,603.32 | $2,318.00 | $13,810.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.76 / $840.90 / $1,194.07
| Professional | | $714.76 | $840.90 | $1,194.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.01 / $1,616.76 / $2,564.51
| Facility | | $1,227.01 | $1,616.76 | $2,564.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.57 / $1,501.28 / $2,078.69
| Professional | | $1,212.57 | $1,501.28 | $2,078.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.83 / $1,520.48 / $2,742.66
| Professional | | $1,148.83 | $1,520.48 | $2,742.66 |
- 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
- $1,148.83 / $1,521.64 / $2,513.69
| Professional | | $1,148.83 | $1,521.64 | $2,513.69 |