- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.48 / $4,895.14 / $5,391.18
| Facility | | $1,723.48 | $4,895.14 | $5,391.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.85 / $1,057.34 / $1,109.56
| Professional | | $691.85 | $1,057.34 | $1,109.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.19 / $1,018.19 / $1,018.19
| Professional | | $1,018.19 | $1,018.19 | $1,018.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.94 / $1,695.96 / $3,900.51
| Facility | | $873.94 | $1,695.96 | $3,900.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,291.88 / $6,291.88 / $6,291.88
| Professional | | $6,291.88 | $6,291.88 | $6,291.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.64 / $1,762.25 / $3,224.26
| Professional | | $1,370.64 | $1,762.25 | $3,224.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.96 / $5,391.18 / $5,391.18
| Facility | | $2,008.96 | $5,391.18 | $5,391.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.71 / $1,109.56 / $5,391.18
| Professional | | $856.71 | $1,109.56 | $5,391.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,931.95 / $1,958.06 / $2,610.73
| Professional | | $1,931.95 | $1,958.06 | $2,610.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.58 / $1,649.64 / $4,332.29
| Facility | | $909.58 | $1,649.64 | $4,332.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,291.88 / $6,291.88 / $6,291.88
| Professional | | $6,291.88 | $6,291.88 | $6,291.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,305.36 / $1,435.91
| Facility | | $1,305.36 | $1,305.36 | $1,435.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,305.36 / $1,435.91
| Professional | | $1,305.36 | $1,305.36 | $1,435.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $2,363.23
| Professional | | $548.26 | $783.22 | $2,363.23 |