- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.49 / $4,029.32 / $5,620.63
| Facility | | $1,723.49 | $4,029.32 | $5,620.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.00 / $1,459.90 / $1,877.70
| Professional | | $1,075.00 | $1,459.90 | $1,877.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.88 / $1,824.88 / $8,969.29
| Facility | | $1,824.88 | $1,824.88 | $8,969.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.17 / $901.17 / $1,448.54
| Professional | | $901.17 | $901.17 | $1,448.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.37 / $3,914.37 / $10,937.78
| Professional | | $2,007.37 | $3,914.37 | $10,937.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.17 / $4,022.48 / $9,348.39
| Facility | | $1,186.17 | $4,022.48 | $9,348.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.59 / $1,232.83 / $3,610.45
| Professional | | $927.59 | $1,232.83 | $3,610.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.88 / $2,189.86 / $2,700.82
| Professional | | $1,824.88 | $2,189.86 | $2,700.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.49 / $2,712.26 / $4,005.22
| Facility | | $1,723.49 | $2,712.26 | $4,005.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.88 / $3,129.00 / $4,309.49
| Professional | | $1,824.88 | $3,129.00 | $4,309.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,734.91 / $2,485.86 / $7,787.49
| Facility | | $1,734.91 | $2,485.86 | $7,787.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.62 / $2,485.86 / $7,787.49
| Professional | | $1,737.62 | $2,485.86 | $7,787.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.88 / $1,824.88 / $1,824.88
| Facility | | $1,824.88 | $1,824.88 | $1,824.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.45 / $1,094.93 / $2,485.86
| Professional | | $766.45 | $1,094.93 | $2,485.86 |