- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,011.87 / $8,317.64
| Facility | | $933.25 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $912.01 / $1,778.28
| Professional | | $758.58 | $912.01 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $2,187.76
| Professional | | $851.14 | $1,258.93 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,288.25 / $5,495.41
| Professional | | $870.96 | $1,288.25 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $1,862.09
| Professional | | $831.76 | $1,071.52 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,258.93
| Professional | | $831.76 | $1,047.13 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,445.44 / $2,041.74
| Professional | | $1,148.15 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $1,737.80
| Facility | | $812.83 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $6,918.31
| Facility | | $794.33 | $1,071.52 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $6,918.31
| Professional | | $794.33 | $1,071.52 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,079.46 / $14,125.38
| Facility | | $3,715.35 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,023.29 / $1,659.59
| Professional | | $645.65 | $1,023.29 | $1,659.59 |