- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.89 / $1,243.89 / $2,168.00
| Facility | | $1,243.89 | $1,243.89 | $2,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.60 / $1,286.07 / $2,193.77
| Professional | | $1,171.60 | $1,286.07 | $2,193.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,046.52 / $12,222.68 / $24,627.71
| Facility | | $6,046.52 | $12,222.68 | $24,627.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,246.58 / $3,626.22 / $4,745.42
| Professional | | $2,246.58 | $3,626.22 | $4,745.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,071.00 / $4,357.30 / $10,482.07
| Facility | | $3,071.00 | $4,357.30 | $10,482.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,302.84 / $3,668.37 / $5,448.09
| Professional | | $2,302.84 | $3,668.37 | $5,448.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,791.81 / $3,983.62 / $8,253.60
| Facility | | $2,791.81 | $3,983.62 | $8,253.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,084.92 / $3,279.77 / $4,996.22
| Professional | | $2,084.92 | $3,279.77 | $4,996.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.89 / $2,172.58 / $5,331.00
| Facility | | $1,243.89 | $2,172.58 | $5,331.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.53 / $2,549.55 / $5,249.06
| Professional | | $1,434.53 | $2,549.55 | $5,249.06 |
- 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
- $1,434.53 / $2,477.83 / $5,097.22
| Professional | | $1,434.53 | $2,477.83 | $5,097.22 |