- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,089.30 / $8,709.64
| Facility | | $1,230.27 | $2,089.30 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,513.56 / $3,715.35
| Professional | | $1,230.27 | $1,513.56 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $3,467.37
| Professional | | $1,412.54 | $1,995.26 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,949.84 / $3,311.31
| Professional | | $1,380.38 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,905.46 / $4,073.80
| Facility | | $1,230.27 | $1,905.46 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,949.84
| Professional | | $1,778.28 | $1,778.28 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,778.28 / $3,090.30
| Professional | | $1,258.93 | $1,778.28 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $37,153.52 / $37,153.52
| Facility | | $56.23 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $19,952.62
| Professional | | $18,620.87 | $18,620.87 | $19,952.62 |