- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $7,079.46
| Facility | | $1,513.56 | $1,513.56 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,513.56 / $2,454.71
| Professional | | $1,348.96 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $12,589.25
| Facility | | $2,630.27 | $6,025.60 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,630.78 / $5,495.41
| Professional | | $2,398.83 | $3,630.78 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,370.32 / $12,882.50
| Facility | | $3,801.89 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,365.16 / $6,606.93
| Professional | | $2,630.27 | $4,365.16 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,248.07 / $10,232.93
| Facility | | $4,168.69 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,715.35 / $5,888.44
| Professional | | $2,691.53 | $3,715.35 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,884.03 / $5,370.32
| Facility | | $1,548.82 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $8,317.64
| Professional | | $1,445.44 | $2,691.53 | $8,317.64 |
- 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
- $1,479.11 / $2,630.27 / $5,370.32
| Professional | | $1,479.11 | $2,630.27 | $5,370.32 |