- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.26 / $3,202.20 / $6,235.75
| Facility | | $1,886.26 | $3,202.20 | $6,235.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,553.39 / $1,797.50 / $2,030.50
| Professional | | $1,553.39 | $1,797.50 | $2,030.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $3,643.81 / $6,102.61
| Facility | | $97.00 | $3,643.81 | $6,102.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,596.38 / $3,106.78 / $3,927.86
| Facility | | $2,596.38 | $3,106.78 | $3,927.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.20 / $3,256.57 / $8,654.61
| Facility | | $1,549.20 | $3,256.57 | $8,654.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.70 / $1,442.43 / $2,062.82
| Professional | | $1,009.70 | $1,442.43 | $2,062.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.11 / $1,549.20 / $2,153.10
| Professional | | $1,348.11 | $1,549.20 | $2,153.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,219.13 / $2,219.13 / $2,219.13
| Professional | | $2,219.13 | $2,219.13 | $2,219.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.71 / $1,331.48 / $2,629.45
| Professional | | $1,242.71 | $1,331.48 | $2,629.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,686.20 / $3,750.32 / $6,346.69
| Facility | | $1,686.20 | $3,750.32 | $6,346.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.86 / $2,549.86 / $3,187.33
| Professional | | $2,549.86 | $2,549.86 | $3,187.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.96 / $2,662.96 / $2,662.96
| Facility | | $2,662.96 | $2,662.96 | $2,662.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.03 / $1,331.48 / $2,662.96
| Professional | | $932.03 | $1,331.48 | $2,662.96 |