- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,905.46 / $2,951.21
| Professional | | $1,174.90 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $13,803.84 / $32,359.37
| Facility | | $1,995.26 | $13,803.84 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,047.13
| Professional | | $831.76 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,413.10 / $17,782.79
| Facility | | $5,248.07 | $7,413.10 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,454.71 / $2,818.38
| Professional | | $2,238.72 | $2,454.71 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,079.46 / $13,803.84
| Facility | | $5,754.40 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $3,090.30
| Professional | | $2,238.72 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,467.37 / $9,332.54
| Facility | | $1,862.09 | $3,467.37 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $2,137.96 / $7,943.28
| Professional | | $776.25 | $2,137.96 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,495.41 / $10,715.19
| Facility | | $1,584.89 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $2,089.30 / $4,897.79
| Professional | | $724.44 | $2,089.30 | $4,897.79 |