- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,890.45 / $5,370.32
| Facility | | $1,230.27 | $3,890.45 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,318.26 / $1,621.81
| Professional | | $1,148.15 | $1,318.26 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,677.35 / $8,317.64
| Facility | | $1,905.46 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,737.80 / $6,606.93
| Professional | | $1,047.13 | $1,737.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,348.96 / $2,818.38
| Facility | | $1,174.90 | $1,348.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,511.89
| Professional | | $2,137.96 | $2,137.96 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,951.21
| Professional | | $2,511.89 | $2,511.89 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $2,818.38
| Professional | | $1,737.80 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,677.35 / $8,317.64
| Facility | | $1,905.46 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,737.80 / $6,606.93
| Professional | | $1,047.13 | $1,737.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,737.80 / $2,089.30
| Facility | | $1,047.13 | $1,737.80 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $3,019.95
| Professional | | $1,047.13 | $1,348.96 | $3,019.95 |