- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.73 / $1,732.73 / $1,732.73
| Facility | | $1,732.73 | $1,732.73 | $1,732.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,693.49 / $1,850.01 / $2,932.00
| Professional | | $1,693.49 | $1,850.01 | $2,932.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,869.40 / $32,422.94 / $66,228.75
| Facility | | $8,869.40 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,355.68 / $5,402.14 / $6,867.23
| Professional | | $3,355.68 | $5,402.14 | $6,867.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,275.64 / $6,066.54 / $14,593.87
| Facility | | $4,275.64 | $6,066.54 | $14,593.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,201.83 / $5,100.43 / $7,574.94
| Professional | | $3,201.83 | $5,100.43 | $7,574.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,886.96 / $5,546.27 / $11,491.24
| Facility | | $3,886.96 | $5,546.27 | $11,491.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,898.84 / $4,561.07 / $6,946.66
| Professional | | $2,898.84 | $4,561.07 | $6,946.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $2,979.77 / $4,800.75
| Facility | | $1,751.00 | $2,979.77 | $4,800.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.65 / $3,618.27 / $7,472.44
| Professional | | $2,039.65 | $3,618.27 | $7,472.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,178.26 / $3,883.25 / $7,227.88
| Professional | | $2,178.26 | $3,883.25 | $7,227.88 |