- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.45 / $2,737.37 / $5,406.45
| Facility | | $1,612.45 | $2,737.37 | $5,406.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.90 / $1,536.57 / $1,821.12
| Professional | | $1,327.90 | $1,536.57 | $1,821.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,219.48 / $2,655.80 / $3,357.69
| Facility | | $2,219.48 | $2,655.80 | $3,357.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.40 / $3,125.78 / $8,276.04
| Facility | | $1,612.40 | $3,125.78 | $8,276.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.36 / $1,549.20 / $2,340.06
| Professional | | $1,190.36 | $1,549.20 | $2,340.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.00 / $1,897.00 / $2,883.44
| Professional | | $1,897.00 | $1,897.00 | $2,883.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.20 / $1,138.20 / $1,612.45
| Professional | | $1,138.20 | $1,138.20 | $1,612.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.14 / $1,233.05 / $3,083.24
| Professional | | $863.14 | $1,233.05 | $3,083.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,692.98 / $3,205.93 / $5,690.53
| Facility | | $1,692.98 | $3,205.93 | $5,690.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,311.04 / $2,311.04 / $2,768.89
| Professional | | $2,311.04 | $2,311.04 | $2,768.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,276.40 / $2,276.40 / $2,276.40
| Facility | | $2,276.40 | $2,276.40 | $2,276.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.74 / $1,138.20 / $2,276.40
| Professional | | $796.74 | $1,138.20 | $2,276.40 |