- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.16 / $1,076.16 / $3,133.89
| Facility | | $1,076.16 | $1,076.16 | $3,133.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.55 / $1,038.18 / $1,076.16
| Professional | | $949.55 | $1,038.18 | $1,076.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,808.53 / $6,165.76 / $7,786.33
| Facility | | $4,808.53 | $6,165.76 | $7,786.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.00 / $1,440.00 / $2,070.14
| Professional | | $1,440.00 | $1,440.00 | $2,070.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.86 / $1,012.86 / $1,975.08
| Professional | | $1,012.86 | $1,012.86 | $1,975.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.95 / $2,057.38 / $6,486.67
| Facility | | $822.95 | $2,057.38 | $6,486.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,542.30 / $1,542.30 / $1,847.85
| Professional | | $1,542.30 | $1,542.30 | $1,847.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,519.28 / $1,873.78
| Professional | | $1,266.07 | $1,519.28 | $1,873.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.55 / $1,266.07 / $2,152.32
| Facility | | $949.55 | $1,266.07 | $2,152.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,494.00 / $2,215.62 / $3,038.57
| Professional | | $1,494.00 | $2,215.62 | $3,038.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.25 / $1,455.98 / $5,367.63
| Facility | | $886.25 | $1,455.98 | $5,367.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.25 / $1,455.98 / $5,402.83
| Professional | | $886.25 | $1,455.98 | $5,402.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $658.36 / $1,455.98
| Professional | | $531.75 | $658.36 | $1,455.98 |