- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,829.98 / $1,829.98 / $9,768.00
| Facility | | $1,829.98 | $1,829.98 | $9,768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.98 / $1,829.98 / $3,052.71
| Professional | | $1,829.98 | $1,829.98 | $3,052.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,610.82 / $12,049.23 / $23,682.56
| Facility | | $7,610.82 | $12,049.23 | $23,682.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,132.39 / $4,873.85 / $6,838.60
| Professional | | $3,132.39 | $4,873.85 | $6,838.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,544.01 / $6,443.98 / $15,501.86
| Facility | | $4,544.01 | $6,443.98 | $15,501.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,657.32 / $6,212.80 / $8,774.42
| Professional | | $3,657.32 | $6,212.80 | $8,774.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,693.96 / $5,891.34 / $12,206.19
| Facility | | $3,693.96 | $5,891.34 | $12,206.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,219.93 / $5,510.26 / $7,302.27
| Professional | | $3,219.93 | $5,510.26 | $7,302.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.44 / $3,741.22 / $10,533.00
| Facility | | $2,454.44 | $3,741.22 | $10,533.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.94 / $4,817.85 / $10,791.44
| Professional | | $2,448.94 | $4,817.85 | $10,791.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,331.00 / $11,165.00 / $19,570.91
| Facility | | $5,331.00 | $11,165.00 | $19,570.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.94 / $4,583.68 / $7,428.53
| Professional | | $2,448.94 | $4,583.68 | $7,428.53 |