- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,677.66 / $1,677.66 / $1,677.66
| Facility | | $1,677.66 | $1,677.66 | $1,677.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.18 / $1,841.22 / $3,061.87
| Professional | | $1,657.18 | $1,841.22 | $3,061.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $11,933.65 / $23,333.99
| Facility | | $7,466.88 | $11,933.65 | $23,333.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,213.30 / $5,450.29 / $6,610.42
| Professional | | $3,213.30 | $5,450.29 | $6,610.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,902.26 / $6,090.42 / $14,651.34
| Facility | | $3,902.26 | $6,090.42 | $14,651.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,101.08 / $5,542.38 / $7,620.10
| Professional | | $3,101.08 | $5,542.38 | $7,620.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,381.66 / $5,557.91 / $11,536.49
| Facility | | $3,381.66 | $5,557.91 | $11,536.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,072.10 / $5,056.52 / $6,967.02
| Professional | | $3,072.10 | $5,056.52 | $6,967.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.52 / $2,835.25 / $5,223.42
| Facility | | $1,660.52 | $2,835.25 | $5,223.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.38 / $4,266.02 / $13,541.44
| Professional | | $2,133.38 | $4,266.02 | $13,541.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,044.49 / $3,972.02 / $7,444.26
| Professional | | $2,044.49 | $3,972.02 | $7,444.26 |