- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.35 / $1,415.71 / $6,781.00
| Facility | | $1,136.35 | $1,415.71 | $6,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.35 / $1,415.71 / $2,497.16
| Professional | | $1,136.35 | $1,415.71 | $2,497.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,293.11 / $10,614.48 / $21,650.55
| Facility | | $5,293.11 | $10,614.48 | $21,650.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,196.66 / $3,504.24 / $5,222.64
| Professional | | $2,196.66 | $3,504.24 | $5,222.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,635.21 / $5,155.18 / $12,401.49
| Facility | | $3,635.21 | $5,155.18 | $12,401.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,583.13 / $4,529.60 / $6,307.90
| Professional | | $2,583.13 | $4,529.60 | $6,307.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,955.17 / $4,713.07 / $9,764.95
| Facility | | $2,955.17 | $4,713.07 | $9,764.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.58 / $3,661.83 / $5,836.53
| Professional | | $2,321.58 | $3,661.83 | $5,836.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,721.36 / $2,425.96 / $7,872.00
| Facility | | $1,721.36 | $2,425.96 | $7,872.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.37 / $4,065.03 / $10,093.60
| Professional | | $1,941.37 | $4,065.03 | $10,093.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.37 / $3,611.32 / $5,898.26
| Professional | | $1,941.37 | $3,611.32 | $5,898.26 |