- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.42 / $2,081.28 / $6,060.90
| Facility | | $1,836.42 | $2,081.28 | $6,060.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,836.42 / $2,007.82 / $2,081.28
| Professional | | $1,836.42 | $2,007.82 | $2,081.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,299.62 / $11,924.49 / $15,058.64
| Facility | | $9,299.62 | $11,924.49 | $15,058.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.07 / $9.07 / $15.14
| Professional | | $9.07 | $9.07 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,958.85 / $1,958.85 / $3,819.76
| Professional | | $1,958.85 | $1,958.85 | $3,819.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.56 / $5,397.47 / $12,543.92
| Facility | | $1,591.56 | $5,397.47 | $12,543.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,982.60 / $2,982.60 / $3,573.49
| Professional | | $2,982.60 | $2,982.60 | $3,573.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,938.27 / $3,623.87
| Professional | | $2,448.56 | $2,938.27 | $3,623.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.42 / $2,448.56 / $4,162.56
| Facility | | $1,836.42 | $2,448.56 | $4,162.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,889.00 / $4,284.97 / $5,876.54
| Professional | | $2,889.00 | $4,284.97 | $5,876.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,829.07 / $2,815.84 / $4,546.00
| Facility | | $1,829.07 | $2,815.84 | $4,546.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.07 / $2,815.84 / $4,546.00
| Professional | | $1,829.07 | $2,815.84 | $4,546.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,224.28 / $2,815.84
| Professional | | $1,028.40 | $1,224.28 | $2,815.84 |