- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,511.89 / $4,265.80
| Professional | | $2,187.76 | $2,511.89 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $38,904.51 / $83,176.38
| Facility | | $15,135.61 | $38,904.51 | $83,176.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,025.60 / $9,120.11
| Professional | | $3,981.07 | $6,025.60 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $8,317.64 / $19,952.62
| Facility | | $5,888.44 | $8,317.64 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,760.83 / $10,000.00
| Professional | | $3,981.07 | $6,760.83 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,943.28 / $15,488.17
| Facility | | $6,456.54 | $7,943.28 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,623.41 / $9,120.11
| Professional | | $4,265.80 | $5,623.41 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,467.37 / $6,309.57
| Facility | | $2,137.96 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,466.84 / $12,882.50
| Professional | | $2,454.71 | $4,466.84 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,311.31 / $8,511.38
| Facility | | $1,445.44 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,365.16 / $8,709.64
| Professional | | $2,454.71 | $4,365.16 | $8,709.64 |