- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $7,779.46
| Facility | | $1,730.32 | $1,730.32 | $7,779.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,868.75 / $32,380.56
| Professional | | $1,730.32 | $1,868.75 | $32,380.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.91 / $1,617.65 / $3,996.62
| Facility | | $1,371.91 | $1,617.65 | $3,996.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.68 / $1,721.06 / $1,737.10
| Professional | | $1,389.68 | $1,721.06 | $1,737.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,094.61 / $2,660.43 / $5,249.66
| Facility | | $2,094.61 | $2,660.43 | $5,249.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.84 / $1,933.84 / $2,161.32
| Professional | | $1,718.84 | $1,933.84 | $2,161.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.05 / $4,133.59 / $6,012.50
| Facility | | $1,976.05 | $4,133.59 | $6,012.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,701.83 / $1,701.83 / $2,314.48
| Professional | | $1,701.83 | $1,701.83 | $2,314.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.69 / $2,565.90 / $3,575.33
| Facility | | $640.69 | $2,565.90 | $3,575.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.10 / $1,933.76 / $3,323.26
| Professional | | $1,737.10 | $1,933.76 | $3,323.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,926.21 / $3,736.28
| Professional | | $1,730.32 | $1,926.21 | $3,736.28 |