- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.77 / $1,206.77 / $9,480.00
| Facility | | $1,206.77 | $1,206.77 | $9,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.35 / $1,294.28 / $3,259.88
| Professional | | $1,181.35 | $1,294.28 | $3,259.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.71 / $8,289.08 / $15,949.15
| Facility | | $4,917.71 | $8,289.08 | $15,949.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,775.62 / $2,452.96 / $3,966.25
| Professional | | $1,775.62 | $2,452.96 | $3,966.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,804.98 / $3,979.86 / $9,574.09
| Facility | | $2,804.98 | $3,979.86 | $9,574.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,904.40 / $3,125.63 / $4,927.10
| Professional | | $1,904.40 | $3,125.63 | $4,927.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,281.42 / $3,638.54 / $7,538.65
| Facility | | $2,281.42 | $3,638.54 | $7,538.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,647.86 / $2,654.54 / $4,518.45
| Professional | | $1,647.86 | $2,654.54 | $4,518.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.95 / $2,342.78 / $10,878.00
| Facility | | $1,343.95 | $2,342.78 | $10,878.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.39 / $2,192.62 / $6,411.60
| Professional | | $1,291.39 | $2,192.62 | $6,411.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,331.00 / $10,421.57 / $13,308.93
| Facility | | $5,331.00 | $10,421.57 | $13,308.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.39 / $2,077.21 / $4,285.06
| Professional | | $1,291.39 | $2,077.21 | $4,285.06 |