- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $5,495.41
| Facility | | $4,466.84 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,370.32 / $10,715.19
| Professional | | $4,466.84 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $20,417.38 / $25,118.86
| Facility | | $18,620.87 | $20,417.38 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $8,912.51 / $9,332.54
| Professional | | $7,762.47 | $8,912.51 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,244.36 / $10,000.00
| Professional | | $2,344.23 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,244.36 / $14,125.38
| Facility | | $3,090.30 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,317.64 / $10,000.00
| Professional | | $4,786.30 | $8,317.64 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,549.93 / $10,471.29
| Professional | | $7,079.46 | $9,549.93 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,265.80 / $9,549.93
| Professional | | $4,073.80 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $15,488.17 / $26,302.68
| Facility | | $3,715.35 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,079.46 / $10,471.29
| Professional | | $4,677.35 | $7,079.46 | $10,471.29 |