- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,624.33 / $1,923.54 / $3,560.56
| Facility | | $1,624.33 | $1,923.54 | $3,560.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.45 / $1,923.54 / $2,786.69
| Professional | | $1,448.45 | $1,923.54 | $2,786.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,420.10 / $4,508.51 / $8,840.21
| Facility | | $4,420.10 | $4,508.51 | $8,840.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.27 / $2,025.27 / $6,456.67
| Professional | | $2,025.27 | $2,025.27 | $6,456.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,424.81 / $3,682.59 / $3,682.59
| Facility | | $3,424.81 | $3,682.59 | $3,682.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,682.59 / $3,682.59 / $3,682.59
| Professional | | $3,682.59 | $3,682.59 | $3,682.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.76 / $2,637.76 / $2,637.76
| Facility | | $2,637.76 | $2,637.76 | $2,637.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,925.56 / $1,925.56 / $2,637.76
| Professional | | $1,925.56 | $1,925.56 | $2,637.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $4,420.10 / $9,945.25
| Facility | | $319.00 | $4,420.10 | $9,945.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,453.16 / $3,315.08 / $8,053.44
| Professional | | $2,453.16 | $3,315.08 | $8,053.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,657.39 / $2,823.48 / $3,682.59
| Professional | | $2,657.39 | $2,823.48 | $3,682.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,637.76 / $4,420.10
| Facility | | $597.00 | $2,637.76 | $4,420.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,925.56 / $2,633.38 / $5,909.06
| Professional | | $1,925.56 | $2,633.38 | $5,909.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.10 / $2,375.13 / $3,809.80
| Professional | | $1,470.10 | $2,375.13 | $3,809.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,657.39 / $2,657.39 / $2,761.52
| Facility | | $2,657.39 | $2,657.39 | $2,761.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,657.39 / $2,657.39 / $2,823.48
| Professional | | $2,657.39 | $2,657.39 | $2,823.48 |