- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $8,128.31
| Facility | | $1,737.80 | $1,737.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,862.09 / $2,951.21
| Professional | | $1,659.59 | $1,862.09 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $38,904.51 / $83,176.38
| Facility | | $11,220.18 | $38,904.51 | $83,176.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,365.16 / $6,606.93
| Professional | | $2,884.03 | $4,365.16 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,309.57 / $15,135.61
| Facility | | $4,466.84 | $6,309.57 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,011.87 / $7,585.78
| Professional | | $3,019.95 | $5,011.87 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,025.60 / $11,748.98
| Facility | | $4,786.30 | $6,025.60 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,265.80 / $6,760.83
| Professional | | $3,235.94 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,162.28 / $7,585.78
| Facility | | $1,862.09 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,388.44 / $9,772.37
| Professional | | $1,737.80 | $3,388.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $8,128.31 / $28,183.83
| Facility | | $1,584.89 | $8,128.31 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,235.94 / $6,456.54
| Professional | | $1,778.28 | $3,235.94 | $6,456.54 |