- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,004.01 / $2,004.01 / $2,004.01
| Facility | | $2,004.01 | $2,004.01 | $2,004.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,964.98 / $2,041.22 / $3,206.26
| Professional | | $1,964.98 | $2,041.22 | $3,206.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $15,452.02
| Facility | | $2,088.76 | $5,302.71 | $15,452.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,570.12 / $5,733.15 / $7,436.75
| Professional | | $3,570.12 | $5,733.15 | $7,436.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,849.78 / $6,881.14 / $16,553.50
| Facility | | $4,849.78 | $6,881.14 | $16,553.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,636.62 / $5,793.06 / $8,603.58
| Professional | | $3,636.62 | $5,793.06 | $8,603.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,408.89 / $6,291.01 / $13,034.26
| Facility | | $4,408.89 | $6,291.01 | $13,034.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,292.48 / $5,179.38 / $7,889.98
| Professional | | $3,292.48 | $5,179.38 | $7,889.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,103.35 / $3,760.40 / $5,895.29
| Facility | | $2,103.35 | $3,760.40 | $5,895.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,218.44 / $3,984.59 / $8,150.09
| Professional | | $2,218.44 | $3,984.59 | $8,150.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,369.21 / $4,329.28 / $8,073.31
| Professional | | $2,369.21 | $4,329.28 | $8,073.31 |