- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.30 / $2,264.92 / $3,760.10
| Facility | | $1,139.30 | $2,264.92 | $3,760.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.30 / $1,245.63 / $1,291.20
| Professional | | $1,139.30 | $1,245.63 | $1,291.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,769.39 / $7,397.82 / $9,342.21
| Facility | | $5,769.39 | $7,397.82 | $9,342.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $239.16 / $405.85
| Professional | | $239.16 | $239.16 | $405.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.25 / $1,367.15 / $2,665.94
| Professional | | $1,215.25 | $1,367.15 | $2,665.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.39 / $3,348.34 / $7,781.66
| Facility | | $987.39 | $3,348.34 | $7,781.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.06 / $1,850.06 / $2,216.58
| Professional | | $1,850.06 | $1,850.06 | $2,216.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.06 / $1,822.87 / $2,248.21
| Professional | | $1,519.06 | $1,822.87 | $2,248.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.66 / $1,519.06 / $2,582.40
| Facility | | $1,207.66 | $1,519.06 | $2,582.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.00 / $3,007.74 / $3,645.74
| Professional | | $2,081.00 | $3,007.74 | $3,645.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.33 / $1,685.85 / $2,820.29
| Facility | | $1,063.33 | $1,685.85 | $2,820.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.33 / $1,727.17 / $2,820.29
| Professional | | $1,063.33 | $1,727.17 | $2,820.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.15 / $1,519.06 / $2,278.59
| Facility | | $1,367.15 | $1,519.06 | $2,278.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.01 / $759.53 / $1,746.92
| Professional | | $638.01 | $759.53 | $1,746.92 |