- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.38 / $1,442.71 / $3,928.60
| Facility | | $1,115.38 | $1,442.71 | $3,928.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.38 / $1,442.71 / $6,732.46
| Professional | | $1,115.38 | $1,442.71 | $6,732.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,271.26 / $4,302.59 / $8,322.61
| Facility | | $3,271.26 | $4,302.59 | $8,322.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.40 / $2,075.38 / $2,958.88
| Professional | | $1,176.40 | $2,075.38 | $2,958.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.98 / $1,114.98 / $1,114.98
| Facility | | $1,114.98 | $1,114.98 | $1,114.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,332.09 / $3,064.43 / $4,712.56
| Professional | | $2,332.09 | $3,064.43 | $4,712.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.44 / $2,380.46 / $4,822.85
| Facility | | $1,298.44 | $2,380.46 | $4,822.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,012.62 / $3,413.71 / $8,957.68
| Professional | | $2,012.62 | $3,413.71 | $8,957.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.48 / $3,141.04 / $4,129.01
| Facility | | $1,226.48 | $3,141.04 | $4,129.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,646.27 / $3,450.37 / $4,122.78
| Professional | | $2,646.27 | $3,450.37 | $4,122.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,012.62 / $3,436.94 / $4,334.88
| Professional | | $2,012.62 | $3,436.94 | $4,334.88 |