- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,238.72 / $2,238.72
| Facility | | $1,513.56 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,905.46 / $4,897.79
| Professional | | $1,412.54 | $1,905.46 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $12,022.64
| Facility | | $3,388.44 | $3,388.44 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,949.84 / $3,162.28
| Professional | | $1,905.46 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $3,388.44
| Professional | | $2,041.74 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,454.71 / $2,454.71
| Facility | | $1,548.82 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $2,454.71
| Professional | | $1,819.70 | $1,819.70 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,691.53 / $7,762.47
| Facility | | $1,737.80 | $2,691.53 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,778.28 / $19,054.61
| Professional | | $1,230.27 | $1,778.28 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,691.53 / $2,691.53
| Facility | | $2,089.30 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,659.59 / $2,398.83
| Professional | | $1,230.27 | $1,659.59 | $2,398.83 |