- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,488.92 / $2,488.92 / $6,703.00
| Facility | | $2,488.92 | $2,488.92 | $6,703.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,892.51 / $2,488.92 / $2,911.02
| Professional | | $1,892.51 | $2,488.92 | $2,911.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.37 / $5,607.04 / $14,527.33
| Facility | | $4,786.37 | $5,607.04 | $14,527.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,296.10 / $2,553.78 / $6,697.86
| Professional | | $2,296.10 | $2,553.78 | $6,697.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,280.56 / $5,097.31 / $6,881.37
| Facility | | $3,280.56 | $5,097.31 | $6,881.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,313.25 / $4,587.58 / $10,914.36
| Professional | | $3,313.25 | $4,587.58 | $10,914.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,297.39 / $3,297.39 / $4,954.72
| Facility | | $3,297.39 | $3,297.39 | $4,954.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,407.09 / $2,407.09 / $4,238.32
| Professional | | $2,407.09 | $2,407.09 | $4,238.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,297.39 / $3,297.39 / $3,297.39
| Facility | | $3,297.39 | $3,297.39 | $3,297.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,407.09 / $3,297.39 / $3,297.39
| Professional | | $2,407.09 | $3,297.39 | $3,297.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,332.71 / $4,332.71 / $5,097.31
| Facility | | $4,332.71 | $4,332.71 | $5,097.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.37 / $2,542.98 / $3,694.12
| Professional | | $1,589.37 | $2,542.98 | $3,694.12 |