- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.64 / $3,326.12 / $3,432.64
| Facility | | $2,248.64 | $3,326.12 | $3,432.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.64 / $2,702.64 / $4,684.67
| Professional | | $2,248.64 | $2,702.64 | $4,684.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,921.83 / $5,167.92 / $22,719.17
| Facility | | $4,921.83 | $5,167.92 | $22,719.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,735.73 / $2,796.11 / $3,981.97
| Professional | | $2,735.73 | $2,796.11 | $3,981.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,532.34 / $3,532.34 / $3,532.34
| Facility | | $3,532.34 | $3,532.34 | $3,532.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.61 / $2,578.61 / $3,638.31
| Professional | | $2,578.61 | $2,578.61 | $3,638.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.64 / $3,966.60 / $24,019.87
| Facility | | $2,248.64 | $3,966.60 | $24,019.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,902.77 / $2,660.07 / $4,823.80
| Professional | | $1,902.77 | $2,660.07 | $4,823.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,050.06 / $3,050.06 / $3,050.06
| Facility | | $3,050.06 | $3,050.06 | $3,050.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,902.77 / $2,660.07 / $3,518.54
| Professional | | $1,902.77 | $2,660.07 | $3,518.54 |