- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,941.68 / $6,821.48
| Facility | | $2,116.32 | $2,941.68 | $6,821.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,200.98 / $2,906.34
| Professional | | $2,116.32 | $2,200.98 | $2,906.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.60 / $1,926.71 / $6,903.44
| Facility | | $5.60 | $1,926.71 | $6,903.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.57 / $2,116.32 / $2,677.15
| Professional | | $2,062.57 | $2,116.32 | $2,677.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,270.81 / $2,700.42 / $5,756.39
| Facility | | $2,270.81 | $2,700.42 | $5,756.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,116.32 / $2,116.32
| Facility | | $2,116.32 | $2,116.32 | $2,116.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,116.32 / $2,116.32
| Professional | | $2,116.32 | $2,116.32 | $2,116.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.00 / $3,169.86 / $8,090.00
| Facility | | $1,909.00 | $3,169.86 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,982.49 / $1,982.49 / $4,117.24
| Professional | | $1,982.49 | $1,982.49 | $4,117.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,313.62 / $3,330.92 / $5,562.34
| Facility | | $3,313.62 | $3,330.92 | $5,562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,815.11 / $2,815.11 / $10,581.60
| Facility | | $2,815.11 | $2,815.11 | $10,581.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.57 / $2,116.32 / $3,174.48
| Professional | | $2,062.57 | $2,116.32 | $3,174.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.57 / $2,116.32 / $2,962.93
| Professional | | $2,062.57 | $2,116.32 | $2,962.93 |