- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,330.75 / $3,330.75 / $5,811.99
| Facility | | $3,330.75 | $3,330.75 | $5,811.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.98 / $1,135.68 / $1,296.01
| Professional | | $961.98 | $1,135.68 | $1,296.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,171.15 / $2,171.15 / $3,882.02
| Facility | | $2,171.15 | $2,171.15 | $3,882.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.09 / $2,933.91 / $3,515.80
| Professional | | $1,336.09 | $2,933.91 | $3,515.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.07 / $1,296.01 / $2,939.40
| Facility | | $1,002.07 | $1,296.01 | $2,939.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,336.09 / $1,803.72
| Professional | | $1,336.09 | $1,336.09 | $1,803.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,402.89 / $1,870.53
| Facility | | $1,336.09 | $1,402.89 | $1,870.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.48 / $1,603.31 / $3,406.32
| Facility | | $1,202.48 | $1,603.31 | $3,406.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.70 / $1,469.70 / $1,870.53
| Professional | | $1,469.70 | $1,469.70 | $1,870.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,672.18 / $4,326.26 / $5,245.09
| Facility | | $2,672.18 | $4,326.26 | $5,245.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,135.13 / $2,627.41 / $4,202.45
| Professional | | $2,135.13 | $2,627.41 | $4,202.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,004.14 / $2,004.14 / $2,137.73
| Facility | | $2,004.14 | $2,004.14 | $2,137.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $561.16 / $1,402.89
| Professional | | $561.16 | $561.16 | $1,402.89 |