- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $7,079.46
| Facility | | $1,548.82 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $2,454.71
| Professional | | $1,318.26 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,120.11 / $22,908.68
| Facility | | $5,128.61 | $9,120.11 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,630.78 / $5,623.41
| Professional | | $2,454.71 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,623.41 / $13,182.57
| Facility | | $3,981.07 | $5,623.41 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,466.84 / $6,760.83
| Professional | | $2,691.53 | $4,466.84 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,370.32 / $10,471.29
| Facility | | $4,265.80 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,025.60
| Professional | | $2,884.03 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,630.27 / $4,570.88
| Facility | | $1,479.11 | $2,630.27 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,754.23 / $8,317.64
| Professional | | $1,412.54 | $2,754.23 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,467.37 / $7,079.46
| Facility | | $1,380.38 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,691.53 / $5,495.41
| Professional | | $1,479.11 | $2,691.53 | $5,495.41 |