- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,822.02 / $1,822.02 / $1,822.02
| Facility | | $1,822.02 | $1,822.02 | $1,822.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,822.02 / $1,822.02 / $2,719.18
| Professional | | $1,822.02 | $1,822.02 | $2,719.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,763.07 / $17,553.24
| Facility | | $4,184.29 | $9,763.07 | $17,553.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,454.89 / $5,326.00 / $7,473.02
| Professional | | $3,454.89 | $5,326.00 | $7,473.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,491.79 / $6,369.92 / $15,323.71
| Facility | | $4,491.79 | $6,369.92 | $15,323.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,651.89 / $6,141.40 / $8,761.37
| Professional | | $3,651.89 | $6,141.40 | $8,761.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,651.51 / $5,823.64 / $12,065.91
| Facility | | $3,651.51 | $5,823.64 | $12,065.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,215.14 / $5,502.07 / $7,291.42
| Professional | | $3,215.14 | $5,502.07 | $7,291.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,314.96 / $3,250.31 / $4,397.62
| Facility | | $2,314.96 | $3,250.31 | $4,397.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,563.86 / $4,859.51 / $10,884.74
| Professional | | $2,563.86 | $4,859.51 | $10,884.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,563.86 / $5,036.16 / $8,135.45
| Professional | | $2,563.86 | $5,036.16 | $8,135.45 |