- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $6,760.83
| Facility | | $3,235.94 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,235.94 / $5,248.07
| Professional | | $2,884.03 | $3,235.94 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,754.40 / $26,302.68
| Facility | | $2,511.89 | $5,754.40 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,762.47 / $12,022.64
| Professional | | $5,248.07 | $7,762.47 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $11,748.98 / $28,183.83
| Facility | | $8,317.64 | $11,748.98 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,332.54 / $14,125.38
| Professional | | $5,623.41 | $9,332.54 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $11,220.18 / $21,877.62
| Facility | | $8,912.51 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,943.28 / $12,589.25
| Professional | | $6,025.60 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,128.61 / $9,120.11
| Facility | | $3,090.30 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,165.95 / $17,782.79
| Professional | | $3,090.30 | $6,165.95 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,309.57 / $12,589.25
| Facility | | $3,235.94 | $6,309.57 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,888.44 / $11,481.54
| Professional | | $3,162.28 | $5,888.44 | $11,481.54 |