- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.63 / $1,844.62 / $3,493.35
| Facility | | $1,214.63 | $1,844.62 | $3,493.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.27 / $1,214.63 / $1,598.80
| Professional | | $951.27 | $1,214.63 | $1,598.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.41 / $2,867.15 / $3,719.86
| Facility | | $1,179.41 | $2,867.15 | $3,719.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.70 / $1,214.63 / $1,356.32
| Professional | | $971.70 | $1,214.63 | $1,356.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.38 / $1,700.39 / $3,766.33
| Facility | | $1,484.38 | $1,700.39 | $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
- $1,214.63 / $1,238.93 / $1,518.28
| Professional | | $1,214.63 | $1,238.93 | $1,518.28 |
- 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 / $2,477.86
| Professional | | $1,238.93 | $1,238.93 | $2,477.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.68 / $1,892.06 / $3,416.98
| Facility | | $1,312.68 | $1,892.06 | $3,416.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.68 / $2,915.12 / $2,915.12
| Facility | | $1,384.68 | $2,915.12 | $2,915.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.85 / $1,214.63 / $1,626.73
| Professional | | $485.85 | $1,214.63 | $1,626.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.44 / $436.21 / $1,734.86
| Facility | | $415.44 | $436.21 | $1,734.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.85 / $1,214.63 / $1,340.96
| Professional | | $485.85 | $1,214.63 | $1,340.96 |