- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $6,760.83
| Facility | | $1,445.44 | $1,445.44 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,445.44 / $2,951.21
| Professional | | $1,288.25 | $1,445.44 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,803.84 / $32,359.37
| Facility | | $7,943.28 | $13,803.84 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,311.31 / $5,128.61
| Professional | | $2,238.72 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,128.61 / $12,302.69
| Facility | | $3,630.78 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,168.69 / $6,309.57
| Professional | | $2,511.89 | $4,168.69 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,897.79 / $9,772.37
| Facility | | $3,981.07 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,548.13 / $5,623.41
| Professional | | $2,691.53 | $3,548.13 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,884.03 / $9,772.37
| Facility | | $1,445.44 | $2,884.03 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,754.23 / $7,943.28
| Professional | | $1,380.38 | $2,754.23 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,754.40 / $12,589.25
| Facility | | $1,584.89 | $5,754.40 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,630.27 / $5,128.61
| Professional | | $1,412.54 | $2,630.27 | $5,128.61 |