- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.35 / $2,556.33 / $2,556.33
| Facility | | $1,055.35 | $2,556.33 | $2,556.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.98 / $2,321.98 / $2,637.93
| Professional | | $2,321.98 | $2,321.98 | $2,637.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.90 / $2,831.57 / $3,905.90
| Facility | | $1,160.90 | $2,831.57 | $3,905.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.05 / $1,349.92 / $4,246.35
| Professional | | $954.05 | $1,349.92 | $4,246.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.14 / $2,081.52 / $3,646.06
| Facility | | $309.14 | $2,081.52 | $3,646.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.03 / $3,652.50 / $4,832.71
| Facility | | $1,876.03 | $3,652.50 | $4,832.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.35 / $1,748.91 / $8,090.00
| Facility | | $1,055.35 | $1,748.91 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.03 / $1,583.04 / $2,362.66
| Professional | | $1,211.03 | $1,583.04 | $2,362.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.46 / $2,672.86 / $3,701.15
| Professional | | $1,470.46 | $2,672.86 | $3,701.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,539.25 / $2,539.25 / $9,522.00
| Facility | | $2,539.25 | $2,539.25 | $9,522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.94 / $1,459.13 / $11,427.00
| Professional | | $998.94 | $1,459.13 | $11,427.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.04 / $1,817.69 / $2,564.44
| Facility | | $1,545.04 | $1,817.69 | $2,564.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,716.53 / $3,239.23 / $4,820.58
| Facility | | $1,716.53 | $3,239.23 | $4,820.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.94 / $1,349.92 / $2,752.92
| Professional | | $998.94 | $1,349.92 | $2,752.92 |