- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.94 / $1,364.22 / $1,775.46
| Facility | | $1,196.94 | $1,364.22 | $1,775.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.30 / $1,349.00 / $1,775.46
| Professional | | $1,057.30 | $1,349.00 | $1,775.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.25 / $363.08 / $732.85
| Facility | | $180.25 | $363.08 | $732.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.02 / $148.18 / $148.18
| Professional | | $128.02 | $148.18 | $148.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,977.30 / $1,977.30 / $1,977.30
| Facility | | $1,977.30 | $1,977.30 | $1,977.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.24 / $1,682.47 / $1,682.47
| Facility | | $1,293.24 | $1,682.47 | $1,682.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.35 / $1,491.30 / $2,310.00
| Professional | | $172.35 | $1,491.30 | $2,310.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,485.44 / $9,600.49 / $9,950.49
| Facility | | $3,485.44 | $9,600.49 | $9,950.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.09 / $1,035.50 / $1,951.71
| Facility | | $184.09 | $1,035.50 | $1,951.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.91 / $880.60 / $2,728.31
| Professional | | $181.91 | $880.60 | $2,728.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.16 / $1,035.50 / $1,911.31
| Facility | | $190.16 | $1,035.50 | $1,911.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.35 / $1,491.30 / $1,491.30
| Professional | | $172.35 | $1,491.30 | $1,491.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.36 / $869.29 / $1,405.83
| Facility | | $117.36 | $869.29 | $1,405.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.90 / $1,097.30 / $2,086.02
| Professional | | $827.90 | $1,097.30 | $2,086.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.50 / $1,467.50 / $1,610.31
| Professional | | $1,467.50 | $1,467.50 | $1,610.31 |