- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,778.28 / $2,754.23
| Facility | | $1,318.26 | $1,778.28 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,288.25 / $1,548.82
| Professional | | $1,258.93 | $1,288.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $331.13 / $1,862.09
| Facility | | $154.88 | $331.13 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,288.25 / $7,079.46
| Professional | | $371.54 | $1,288.25 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $2,951.21
| Facility | | $1,479.11 | $1,479.11 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $1,148.15
| Professional | | $371.54 | $371.54 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $331.13 / $1,862.09
| Facility | | $154.88 | $331.13 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,288.25 / $7,079.46
| Professional | | $371.54 | $1,288.25 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $371.54
| Facility | | $281.84 | $363.08 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,288.25 / $1,445.44
| Professional | | $371.54 | $1,288.25 | $1,445.44 |