- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.20 / $5,316.71 / $6,353.12
| Facility | | $1,291.20 | $5,316.71 | $6,353.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.44 / $1,230.44 / $1,291.20
| Professional | | $911.44 | $1,230.44 | $1,291.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.86 / $1,184.86 / $1,184.86
| Professional | | $1,184.86 | $1,184.86 | $1,184.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.01 / $1,973.60 / $4,539.03
| Facility | | $1,017.01 | $1,973.60 | $4,539.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,321.87 / $7,321.87 / $7,321.87
| Professional | | $7,321.87 | $7,321.87 | $7,321.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,595.01 / $2,050.73 / $3,752.08
| Professional | | $1,595.01 | $2,050.73 | $3,752.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.47 / $5,241.67 / $6,353.12
| Facility | | $1,691.47 | $5,241.67 | $6,353.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.96 / $1,291.20 / $6,273.72
| Professional | | $996.96 | $1,291.20 | $6,273.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.21 / $2,278.59 / $3,038.12
| Professional | | $2,248.21 | $2,278.59 | $3,038.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.48 / $1,919.40 / $5,040.76
| Facility | | $1,058.48 | $1,919.40 | $5,040.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,321.87 / $7,321.87 / $7,321.87
| Professional | | $7,321.87 | $7,321.87 | $7,321.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.06 / $1,519.06 / $1,670.97
| Facility | | $1,519.06 | $1,519.06 | $1,670.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.06 / $1,519.06 / $1,670.97
| Professional | | $1,519.06 | $1,519.06 | $1,670.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.01 / $911.44 / $2,126.67
| Professional | | $638.01 | $911.44 | $2,126.67 |