- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,035.49 / $2,035.49 / $2,057.17
| Facility | | $2,035.49 | $2,035.49 | $2,057.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.67 / $2,035.49 / $2,488.92
| Professional | | $1,807.67 | $2,035.49 | $2,488.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,859.48 / $3,859.48 / $4,098.77
| Facility | | $3,859.48 | $3,859.48 | $4,098.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.56 / $2,335.56 / $2,950.95
| Professional | | $2,335.56 | $2,335.56 | $2,950.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.59 / $2,162.87 / $2,638.31
| Professional | | $2,154.59 | $2,162.87 | $2,638.31 |
- 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 / $2,407.09 / $3,297.39
| Professional | | $2,407.09 | $2,407.09 | $3,297.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,701.64 / $3,473.53 / $4,631.38
| Professional | | $2,701.64 | $3,473.53 | $4,631.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,231.29 / $2,373.63 / $4,330.37
| Facility | | $1,231.29 | $2,373.63 | $4,330.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,075.12 / $5,069.43 / $6,428.64
| Professional | | $3,075.12 | $5,069.43 | $6,428.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.48 / $2,967.04 / $4,832.67
| Facility | | $2,114.48 | $2,967.04 | $4,832.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,114.48 / $2,967.04 / $4,832.67
| Professional | | $2,114.48 | $2,967.04 | $4,832.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,097.31 / $5,097.31 / $6,116.77
| Facility | | $5,097.31 | $5,097.31 | $6,116.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.18 / $1,925.45 / $2,939.00
| Professional | | $1,829.18 | $1,925.45 | $2,939.00 |