- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.13 / $1,254.13 / $1,343.42
| Facility | | $1,254.13 | $1,254.13 | $1,343.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.13 / $1,254.13 / $1,254.13
| Professional | | $1,254.13 | $1,254.13 | $1,254.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.43 / $296.51 / $573.54
| Facility | | $225.43 | $296.51 | $573.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,743.88 / $3,004.40 / $3,116.32
| Professional | | $2,743.88 | $3,004.40 | $3,116.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,451.35 / $4,314.18 / $4,864.51
| Professional | | $3,451.35 | $4,314.18 | $4,864.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.13 / $2,382.85 / $9,025.95
| Facility | | $1,254.13 | $2,382.85 | $9,025.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.11 / $1,140.11 / $5,491.58
| Professional | | $1,140.11 | $1,140.11 | $5,491.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,280.23 / $3,914.41 / $4,864.51
| Facility | | $2,280.23 | $3,914.41 | $4,864.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,280.23 / $3,914.41 / $8,448.67
| Professional | | $2,280.23 | $3,914.41 | $8,448.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,223.23 / $2,223.23 / $3,876.41
| Professional | | $2,223.23 | $2,223.23 | $3,876.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.10 / $1,140.11 / $3,705.39
| Professional | | $1,083.10 | $1,140.11 | $3,705.39 |