- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.26 / $2,012.54 / $7,920.26
| Facility | | $793.26 | $2,012.54 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.28 / $1,416.14 / $3,525.52
| Professional | | $900.28 | $1,416.14 | $3,525.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.62 / $1,919.45 / $2,807.44
| Professional | | $1,005.62 | $1,919.45 | $2,807.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,588.01 / $2,085.21 / $2,585.31
| Professional | | $1,588.01 | $2,085.21 | $2,585.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.49 / $1,789.94 / $2,755.51
| Facility | | $1,106.49 | $1,789.94 | $2,755.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.18 / $1,763.01 / $2,968.59
| Professional | | $1,469.18 | $1,763.01 | $2,968.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.97 / $1,906.15 / $2,024.74
| Facility | | $1,389.97 | $1,906.15 | $2,024.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.58 / $1,987.30 / $2,755.51
| Facility | | $1,171.58 | $1,987.30 | $2,755.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.52 / $2,188.50 / $2,847.10
| Professional | | $1,656.52 | $2,188.50 | $2,847.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,137.25 / $5,137.25 / $5,137.25
| Facility | | $5,137.25 | $5,137.25 | $5,137.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,851.85 / $2,358.67 / $2,852.92
| Professional | | $1,851.85 | $2,358.67 | $2,852.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.76 / $2,046.80 / $3,153.24
| Professional | | $1,432.76 | $2,046.80 | $3,153.24 |