- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $2,238.72
| Facility | | $1,230.27 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,288.25 / $2,187.76
| Professional | | $1,122.02 | $1,288.25 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $15,135.61 / $29,512.09
| Facility | | $7,762.47 | $15,135.61 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,090.30 / $4,677.35
| Professional | | $2,041.74 | $3,090.30 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $10,964.78
| Facility | | $3,235.94 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,715.35 / $5,623.41
| Professional | | $2,238.72 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,466.84 / $8,709.64
| Facility | | $3,548.13 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $5,011.87
| Professional | | $2,398.83 | $3,162.28 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,290.87 / $9,772.37
| Facility | | $1,230.27 | $2,290.87 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,454.71 / $7,079.46
| Professional | | $1,258.93 | $2,454.71 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,309.57 / $12,589.25
| Facility | | $3,235.94 | $6,309.57 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $4,570.88
| Professional | | $1,258.93 | $2,290.87 | $4,570.88 |