- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.48 / $2,467.52 / $4,228.50
| Facility | | $1,007.48 | $2,467.52 | $4,228.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.00 / $1,214.63 / $1,470.00
| Professional | | $975.00 | $1,214.63 | $1,470.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.93 / $1,384.68 / $3,848.93
| Facility | | $1,179.93 | $1,384.68 | $3,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.93 / $1,214.63 / $1,494.75
| Professional | | $1,179.93 | $1,214.63 | $1,494.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.76 / $1,766.85 / $3,766.33
| Facility | | $1,485.76 | $1,766.85 | $3,766.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.93 / $1,238.93 / $1,238.93
| Facility | | $1,238.93 | $1,238.93 | $1,238.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.93 / $1,238.93 / $1,238.93
| Professional | | $1,238.93 | $1,238.93 | $1,238.93 |
- 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
- $1,238.93 / $1,238.93 / $2,573.01
| Professional | | $1,238.93 | $1,238.93 | $2,573.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.93 / $1,706.75 / $3,810.78
| Facility | | $1,238.93 | $1,706.75 | $3,810.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.68 / $1,384.68 / $2,915.12
| Facility | | $1,384.68 | $1,384.68 | $2,915.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.63 / $1,214.63 / $1,821.95
| Professional | | $1,214.63 | $1,214.63 | $1,821.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.93 / $1,220.27 / $2,564.79
| Facility | | $1,179.93 | $1,220.27 | $2,564.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.63 / $1,214.63 / $1,700.53
| Professional | | $1,214.63 | $1,214.63 | $1,700.53 |