- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.91 / $1,109.91 / $1,109.91
| Facility | | $1,109.91 | $1,109.91 | $1,109.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.04 / $1,109.91 / $1,451.72
| Professional | | $900.04 | $1,109.91 | $1,451.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.13 / $2,007.46 / $3,829.31
| Facility | | $524.13 | $2,007.46 | $3,829.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.11 / $2,020.32 / $6,610.61
| Professional | | $279.11 | $2,020.32 | $6,610.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.70 / $1,695.18 / $2,106.44
| Facility | | $1,421.70 | $1,695.18 | $2,106.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.11 / $2,193.06 / $5,012.38
| Facility | | $1,068.11 | $2,193.06 | $5,012.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.33 / $2,094.34 / $3,789.65
| Professional | | $1,091.33 | $2,094.34 | $3,789.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.81 / $235.52 / $592.95
| Professional | | $119.81 | $235.52 | $592.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.03 / $2,433.56 / $3,064.90
| Professional | | $1,456.03 | $2,433.56 | $3,064.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,929.52 / $1,929.52 / $5,205.62
| Facility | | $1,929.52 | $1,929.52 | $5,205.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.15 / $2,304.44 / $6,610.61
| Professional | | $1,265.15 | $2,304.44 | $6,610.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.15 / $2,020.08 / $4,310.21
| Professional | | $1,265.15 | $2,020.08 | $4,310.21 |