- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $5,011.87
| Facility | | $1,445.44 | $1,445.44 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,513.56 / $2,344.23
| Professional | | $1,318.26 | $1,513.56 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $33,113.11
| Facility | | $8,709.64 | $16,982.44 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,388.44 / $5,370.32
| Professional | | $2,344.23 | $3,388.44 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,248.07 / $12,302.69
| Facility | | $3,715.35 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,265.80 / $6,309.57
| Professional | | $2,511.89 | $4,265.80 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,011.87 / $9,772.37
| Facility | | $3,981.07 | $5,011.87 | $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
- $1,412.54 / $2,454.71 / $6,918.31
| Facility | | $1,412.54 | $2,454.71 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,754.23 / $8,511.38
| Professional | | $1,380.38 | $2,754.23 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,760.83 / $10,715.19
| Facility | | $3,090.30 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,570.40 / $5,128.61
| Professional | | $1,348.96 | $2,570.40 | $5,128.61 |