- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,238.72 / $3,801.89
| Facility | | $1,380.38 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,737.80 / $5,495.41
| Professional | | $1,513.56 | $1,737.80 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $11,220.18
| Facility | | $56.23 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,454.71 / $12,589.25
| Professional | | $1,445.44 | $2,454.71 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,818.38 / $6,025.60
| Professional | | $1,584.89 | $2,818.38 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,630.27 / $8,511.38
| Facility | | $302.00 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,778.28 / $2,754.23
| Professional | | $954.99 | $1,778.28 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,162.28 / $5,128.61
| Professional | | $1,659.59 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $11,220.18
| Facility | | $56.23 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,454.71 / $12,589.25
| Professional | | $1,445.44 | $2,454.71 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,691.53 / $5,370.32
| Professional | | $1,778.28 | $2,691.53 | $5,370.32 |