- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.78 / $1,432.78 / $1,432.78
| Facility | | $1,432.78 | $1,432.78 | $1,432.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.78 / $1,432.78 / $2,069.39
| Professional | | $1,432.78 | $1,432.78 | $2,069.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,867.40 / $6,380.26 / $12,505.66
| Facility | | $2,867.40 | $6,380.26 | $12,505.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,451.41 / $3,786.43 / $5,312.83
| Professional | | $2,451.41 | $3,786.43 | $5,312.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,332.84 / $4,726.38 / $11,369.94
| Facility | | $3,332.84 | $4,726.38 | $11,369.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,705.60 / $4,556.82 / $6,491.12
| Professional | | $2,705.60 | $4,556.82 | $6,491.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.36 / $4,321.04 / $8,952.70
| Facility | | $2,709.36 | $4,321.04 | $8,952.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,382.03 / $4,076.36 / $5,402.05
| Professional | | $2,382.03 | $4,076.36 | $5,402.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.76 / $2,421.40 / $3,700.04
| Facility | | $1,866.76 | $2,421.40 | $3,700.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,902.55 / $3,662.07 / $7,874.72
| Professional | | $1,902.55 | $3,662.07 | $7,874.72 |
- 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
- $1,947.02 / $3,844.72 / $5,913.52
| Professional | | $1,947.02 | $3,844.72 | $5,913.52 |