- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.84 / $1,778.84 / $1,778.84
| Facility | | $1,778.84 | $1,778.84 | $1,778.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.84 / $1,778.84 / $2,652.87
| Professional | | $1,778.84 | $1,778.84 | $2,652.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,547.15 / $17,023.47
| Facility | | $4,184.29 | $9,547.15 | $17,023.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,360.13 / $5,191.47 / $7,284.28
| Professional | | $3,360.13 | $5,191.47 | $7,284.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,383.14 / $6,215.84 / $14,953.04
| Facility | | $4,383.14 | $6,215.84 | $14,953.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,562.15 / $5,992.85 / $8,546.09
| Professional | | $3,562.15 | $5,992.85 | $8,546.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,563.18 / $5,682.77 / $11,774.05
| Facility | | $3,563.18 | $5,682.77 | $11,774.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,136.14 / $5,366.87 / $7,112.25
| Professional | | $3,136.14 | $5,366.87 | $7,112.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,313.96 / $3,168.72 / $4,440.24
| Facility | | $2,313.96 | $3,168.72 | $4,440.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,505.85 / $4,725.71 / $10,585.04
| Professional | | $2,505.85 | $4,725.71 | $10,585.04 |
- 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
- $2,601.98 / $4,496.02 / $7,908.41
| Professional | | $2,601.98 | $4,496.02 | $7,908.41 |