- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.31 / $1,688.03 / $1,688.03
| Facility | | $1,326.31 | $1,688.03 | $1,688.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.31 / $1,693.99 / $2,663.19
| Professional | | $1,326.31 | $1,693.99 | $2,663.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,295.76 / $13,062.59
| Facility | | $4,184.29 | $8,295.76 | $13,062.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,444.48 / $4,024.61 / $5,826.79
| Professional | | $2,444.48 | $4,024.61 | $5,826.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,085.40 / $5,796.59 / $13,944.49
| Facility | | $4,085.40 | $5,796.59 | $13,944.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,667.22 / $4,408.04 / $7,153.41
| Professional | | $2,667.22 | $4,408.04 | $7,153.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,714.00 / $5,299.48 / $10,979.91
| Facility | | $3,714.00 | $5,299.48 | $10,979.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,498.42 / $4,007.30 / $6,522.83
| Professional | | $2,498.42 | $4,007.30 | $6,522.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.76 / $2,693.39 / $4,550.54
| Facility | | $1,674.76 | $2,693.39 | $4,550.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,978.58 / $3,577.93 / $9,893.12
| Professional | | $1,978.58 | $3,577.93 | $9,893.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,852.67 / $3,446.23 / $6,600.59
| Professional | | $1,852.67 | $3,446.23 | $6,600.59 |