- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.45 / $6,545.79 / $7,933.75
| Facility | | $1,612.45 | $6,545.79 | $7,933.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.20 / $1,536.57 / $2,304.85
| Professional | | $1,138.20 | $1,536.57 | $2,304.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.66 / $1,479.66 / $1,479.66
| Professional | | $1,479.66 | $1,479.66 | $1,479.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.25 / $2,599.10 / $6,294.70
| Facility | | $1,800.25 | $2,599.10 | $6,294.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,143.54 / $9,143.54 / $9,143.54
| Professional | | $9,143.54 | $9,143.54 | $9,143.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.85 / $2,560.94 / $4,685.59
| Professional | | $1,991.85 | $2,560.94 | $4,685.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,953.91 / $5,385.58 / $7,834.61
| Facility | | $1,953.91 | $5,385.58 | $7,834.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.00 / $1,612.45 / $7,834.61
| Professional | | $1,245.00 | $1,612.45 | $7,834.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,807.56 / $2,845.50 / $3,794.00
| Professional | | $2,807.56 | $2,845.50 | $3,794.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.56 / $2,936.57 / $6,294.70
| Facility | | $1,846.56 | $2,936.57 | $6,294.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,143.54 / $9,143.54 / $9,143.54
| Professional | | $9,143.54 | $9,143.54 | $9,143.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,897.00 / $1,897.00 / $2,086.69
| Facility | | $1,897.00 | $1,897.00 | $2,086.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.00 / $1,897.00 / $2,086.69
| Professional | | $1,897.00 | $1,897.00 | $2,086.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.74 / $1,138.20 / $2,845.50
| Professional | | $796.74 | $1,138.20 | $2,845.50 |