- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.09 / $1,355.09 / $1,355.09
| Facility | | $1,355.09 | $1,355.09 | $1,355.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.09 / $1,355.09 / $1,962.77
| Professional | | $1,355.09 | $1,355.09 | $1,962.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,675.82 / $12,189.34
| Facility | | $3,692.86 | $7,675.82 | $12,189.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,320.46 / $3,588.56 / $5,035.18
| Professional | | $2,320.46 | $3,588.56 | $5,035.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.70 / $4,462.41 / $10,734.93
| Facility | | $3,146.70 | $4,462.41 | $10,734.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,551.29 / $4,302.32 / $6,120.90
| Professional | | $2,551.29 | $4,302.32 | $6,120.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,558.04 / $4,079.71 / $8,452.70
| Facility | | $2,558.04 | $4,079.71 | $8,452.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,246.17 / $3,843.87 / $5,093.95
| Professional | | $2,246.17 | $3,843.87 | $5,093.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,811.43 / $2,290.10 / $3,500.00
| Facility | | $1,811.43 | $2,290.10 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,803.14 / $3,472.72 / $7,467.55
| Professional | | $1,803.14 | $3,472.72 | $7,467.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,830.67 / $3,724.08 / $6,147.71
| Professional | | $1,830.67 | $3,724.08 | $6,147.71 |