- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.06 / $1,313.06 / $4,828.00
| Facility | | $1,313.06 | $1,313.06 | $4,828.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.35 / $1,356.16 / $2,480.81
| Professional | | $1,236.35 | $1,356.16 | $2,480.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,345.31 / $12,222.68 / $24,627.71
| Facility | | $6,345.31 | $12,222.68 | $24,627.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,371.00 / $3,827.06 / $5,008.24
| Professional | | $2,371.00 | $3,827.06 | $5,008.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,243.57 / $4,602.16 / $11,071.11
| Facility | | $3,243.57 | $4,602.16 | $11,071.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,432.96 / $3,875.66 / $5,755.95
| Professional | | $2,432.96 | $3,875.66 | $5,755.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,948.70 / $4,207.47 / $8,717.41
| Facility | | $2,948.70 | $4,207.47 | $8,717.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,202.73 / $3,465.10 / $5,278.54
| Professional | | $2,202.73 | $3,465.10 | $5,278.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.59 / $2,294.78 / $6,456.62
| Facility | | $1,383.59 | $2,294.78 | $6,456.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,522.91 / $2,706.62 / $5,533.23
| Professional | | $1,522.91 | $2,706.62 | $5,533.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,533.82 / $2,678.99 / $5,373.18
| Professional | | $1,533.82 | $2,678.99 | $5,373.18 |