- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.21 / $1,471.21 / $9,768.00
| Facility | | $1,471.21 | $1,471.21 | $9,768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.21 / $1,629.23 / $3,000.48
| Professional | | $1,471.21 | $1,629.23 | $3,000.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,024.85 / $8,285.45 / $15,635.81
| Facility | | $5,024.85 | $8,285.45 | $15,635.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,158.80 / $2,928.26 / $4,826.13
| Professional | | $2,158.80 | $2,928.26 | $4,826.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,409.41 / $4,837.46 / $11,637.17
| Facility | | $3,409.41 | $4,837.46 | $11,637.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,313.42 / $3,796.96 / $5,985.35
| Professional | | $2,313.42 | $3,796.96 | $5,985.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,773.04 / $4,422.60 / $9,163.12
| Facility | | $2,773.04 | $4,422.60 | $9,163.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.78 / $3,224.69 / $5,488.92
| Professional | | $2,001.78 | $3,224.69 | $5,488.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,569.80 / $2,601.86 / $7,022.25
| Facility | | $1,569.80 | $2,601.86 | $7,022.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,493.40 / $2,600.17 / $5,872.31
| Professional | | $1,493.40 | $2,600.17 | $5,872.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,522.26 / $2,490.96 / $5,191.35
| Professional | | $1,522.26 | $2,490.96 | $5,191.35 |