- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,222.84 / $2,318.00 / $4,846.00
| Facility | | $2,222.84 | $2,318.00 | $4,846.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,190.90 / $2,222.84 / $2,778.56
| Professional | | $2,190.90 | $2,222.84 | $2,778.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,881.00 / $23,381.41 / $33,555.00
| Facility | | $7,881.00 | $23,381.41 | $33,555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,252.23 / $3,188.70 / $4,400.39
| Professional | | $2,252.23 | $3,188.70 | $4,400.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.39 / $2,806.97 / $3,238.82
| Facility | | $2,202.39 | $2,806.97 | $3,238.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.21 / $2,591.05 / $3,238.82
| Professional | | $2,159.21 | $2,591.05 | $3,238.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,390.12 / $3,199.55 / $5,128.02
| Professional | | $2,390.12 | $3,199.55 | $5,128.02 |
- 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
- $2,110.51 / $2,678.27 / $4,566.89
| Professional | | $2,110.51 | $2,678.27 | $4,566.89 |