- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,897.79 / $8,511.38
| Facility | | $2,511.89 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,715.35 / $7,244.36
| Professional | | $2,754.23 | $3,715.35 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $10,000.00
| Facility | | $2,238.72 | $4,897.79 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,801.89 / $6,025.60
| Professional | | $2,754.23 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,890.45 / $5,623.41
| Professional | | $3,235.94 | $3,890.45 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,801.89 / $6,760.83
| Professional | | $2,511.89 | $3,801.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,981.07 / $8,317.64
| Facility | | $2,238.72 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,677.35 / $24,547.09
| Professional | | $2,951.21 | $4,677.35 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,818.38 / $10,471.29
| Facility | | $1,230.27 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,981.07 / $7,079.46
| Professional | | $2,818.38 | $3,981.07 | $7,079.46 |