- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.82 / $2,431.52 / $4,846.00
| Facility | | $2,200.82 | $2,431.52 | $4,846.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,115.42 / $2,303.50 / $3,102.11
| Professional | | $2,115.42 | $2,303.50 | $3,102.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,595.75 / $1,916.80 / $2,721.85
| Professional | | $1,595.75 | $1,916.80 | $2,721.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,026.27 / $2,634.15 / $3,039.41
| Facility | | $2,026.27 | $2,634.15 | $3,039.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,026.27 / $2,431.52 / $3,039.41
| Professional | | $2,026.27 | $2,431.52 | $3,039.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,631.54
| Facility | | $761.00 | $761.00 | $2,631.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,909.47 / $2,629.46 / $4,630.89
| Professional | | $1,909.47 | $2,629.46 | $4,630.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,939.60 / $2,525.19 / $4,415.06
| Professional | | $1,939.60 | $2,525.19 | $4,415.06 |