- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.29 / $1,403.29 / $1,503.20
| Facility | | $1,403.29 | $1,403.29 | $1,503.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.29 / $1,403.29 / $1,403.29
| Professional | | $1,403.29 | $1,403.29 | $1,403.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.01 / $1,538.88 / $2,976.70
| Facility | | $1,170.01 | $1,538.88 | $2,976.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,070.23 / $3,380.65 / $3,486.96
| Professional | | $3,070.23 | $3,380.65 | $3,486.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,551.44 / $3,861.96 / $4,827.46
| Professional | | $2,551.44 | $3,861.96 | $4,827.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.43 / $1,403.29 / $10,099.45
| Facility | | $765.43 | $1,403.29 | $10,099.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.72 / $1,275.72 / $6,144.72
| Professional | | $1,275.72 | $1,275.72 | $6,144.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.44 / $3,720.85 / $4,659.75
| Facility | | $2,551.44 | $3,720.85 | $4,659.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,551.44 / $4,184.35 / $5,315.50
| Professional | | $2,551.44 | $4,184.35 | $5,315.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,487.65 / $2,487.65 / $4,337.45
| Professional | | $2,487.65 | $2,487.65 | $4,337.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.72 / $2,338.82 / $8,504.79
| Facility | | $1,275.72 | $2,338.82 | $8,504.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.93 / $1,275.72 / $1,913.58
| Professional | | $1,211.93 | $1,275.72 | $1,913.58 |