- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $7,943.28
| Facility | | $1,445.44 | $2,691.53 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,445.44 / $3,388.44
| Professional | | $1,122.02 | $1,445.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,511.89 / $3,311.31
| Professional | | $1,479.11 | $2,511.89 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,290.87 / $2,754.23
| Professional | | $1,023.29 | $2,290.87 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,089.30 / $3,162.28
| Facility | | $1,445.44 | $2,089.30 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $3,311.31
| Professional | | $1,737.80 | $2,238.72 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,089.30 / $2,238.72
| Facility | | $1,778.28 | $2,089.30 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $2,818.38
| Facility | | $1,258.93 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $2,089.30 / $3,090.30
| Professional | | $79.43 | $2,089.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,630.27 / $3,467.37
| Professional | | $2,041.74 | $2,630.27 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,344.23 / $3,235.94
| Professional | | $1,548.82 | $2,344.23 | $3,235.94 |