- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,884.03 / $3,801.89
| Facility | | $1,148.15 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $1,548.82
| Professional | | $1,023.29 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,943.28 / $9,549.93
| Facility | | $6,165.95 | $7,943.28 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $912.01
| Professional | | $512.86 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,258.93 / $1,380.38
| Professional | | $1,174.90 | $1,258.93 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $7,943.28
| Facility | | $1,548.82 | $3,801.89 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,238.72
| Professional | | $1,862.09 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,698.24 / $2,137.96
| Professional | | $1,548.82 | $1,698.24 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $2,398.83
| Facility | | $1,148.15 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $3,235.94
| Professional | | $1,000.00 | $1,000.00 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,737.80 / $3,162.28
| Facility | | $1,071.52 | $1,737.80 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,778.28 / $3,162.28
| Professional | | $1,071.52 | $1,778.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,548.82 / $1,862.09
| Facility | | $912.01 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $776.25 / $1,778.28
| Professional | | $645.65 | $776.25 | $1,778.28 |