- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $7,079.46
| Facility | | $1,202.26 | $1,202.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,258.93 / $1,949.84
| Professional | | $1,096.48 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,623.41 / $12,022.64
| Facility | | $2,511.89 | $5,623.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,884.03 / $4,466.84
| Professional | | $1,949.84 | $2,884.03 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,365.16 / $10,471.29
| Facility | | $3,090.30 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,548.13 / $5,248.07
| Professional | | $2,089.30 | $3,548.13 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $8,128.31
| Facility | | $3,388.44 | $4,168.69 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,951.21 / $4,786.30
| Professional | | $2,238.72 | $2,951.21 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,089.30 / $5,888.44
| Facility | | $1,230.27 | $2,089.30 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,238.72 / $6,606.93
| Professional | | $1,174.90 | $2,238.72 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,309.57 / $13,182.57
| Facility | | $1,584.89 | $6,309.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,137.96 / $4,265.80
| Professional | | $1,174.90 | $2,137.96 | $4,265.80 |