- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,740.10 / $4,856.32 / $7,760.85
| Facility | | $1,740.10 | $4,856.32 | $7,760.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.15 / $1,740.10 / $2,112.98
| Professional | | $1,478.15 | $1,740.10 | $2,112.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.60 / $2,570.96 / $6,113.35
| Facility | | $1,664.60 | $2,570.96 | $6,113.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.93 / $1,824.88 / $7,236.80
| Professional | | $1,094.93 | $1,824.88 | $7,236.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.26 / $4,819.72 / $8,951.93
| Facility | | $68.26 | $4,819.72 | $8,951.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.88 / $1,824.88 / $2,485.86
| Professional | | $1,824.88 | $1,824.88 | $2,485.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,423.40 / $2,490.96 / $4,151.60
| Facility | | $1,423.40 | $2,490.96 | $4,151.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.60 / $1,925.20 / $4,757.03
| Professional | | $1,097.60 | $1,925.20 | $4,757.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $5,585.00 / $13,677.19
| Facility | | $83.43 | $5,585.00 | $13,677.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,633.38 / $2,633.38 / $3,098.10
| Professional | | $2,633.38 | $2,633.38 | $3,098.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.88 / $1,824.88 / $5,934.04
| Professional | | $1,824.88 | $1,824.88 | $5,934.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,178.46 / $8,668.18 / $8,668.18
| Facility | | $3,178.46 | $8,668.18 | $8,668.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.93 / $1,491.52 / $9,124.40
| Professional | | $1,094.93 | $1,491.52 | $9,124.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.93 / $1,094.93 / $1,094.93
| Facility | | $1,094.93 | $1,094.93 | $1,094.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.93 / $1,491.52 / $3,480.20
| Professional | | $1,094.93 | $1,491.52 | $3,480.20 |