- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.72 / $1,098.72 / $1,098.72
| Facility | | $1,098.72 | $1,098.72 | $1,098.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.72 / $1,194.47 / $2,111.48
| Professional | | $1,098.72 | $1,194.47 | $2,111.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.65 / $4,651.05 / $15,439.31
| Facility | | $1,474.65 | $4,651.05 | $15,439.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.18 / $1,874.10 / $2,455.73
| Professional | | $1,216.18 | $1,874.10 | $2,455.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,669.06 / $3,247.22 / $4,181.80
| Facility | | $2,669.06 | $3,247.22 | $4,181.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,811.28 / $2,231.21 / $2,231.21
| Professional | | $1,811.28 | $2,231.21 | $2,231.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.52 / $1,523.27 / $1,762.92
| Facility | | $1,454.52 | $1,523.27 | $1,762.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.99 / $1,523.27 / $3,427.13
| Professional | | $1,111.99 | $1,523.27 | $3,427.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.02 / $2,036.02 / $2,137.82
| Professional | | $2,036.02 | $2,036.02 | $2,137.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,607.36 / $1,607.36 / $1,607.36
| Professional | | $1,607.36 | $1,607.36 | $1,607.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,000.88 / $15,439.31 / $15,439.31
| Facility | | $6,000.88 | $15,439.31 | $15,439.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.49 / $1,344.18 / $2,455.73
| Professional | | $1,013.49 | $1,344.18 | $2,455.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,624.58 / $1,624.58 / $1,624.58
| Facility | | $1,624.58 | $1,624.58 | $1,624.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.14 / $1,382.07 / $2,831.84
| Professional | | $1,092.14 | $1,382.07 | $2,831.84 |