- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.74 / $923.88 / $1,710.15
| Facility | | $722.74 | $923.88 | $1,710.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.74 / $927.59 / $1,338.46
| Professional | | $722.74 | $927.59 | $1,338.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,123.00 / $2,165.46 / $4,246.00
| Facility | | $2,123.00 | $2,165.46 | $4,246.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.67 / $1,181.67 / $3,290.32
| Professional | | $1,181.67 | $1,181.67 | $3,290.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.95 / $1,768.76 / $1,768.76
| Facility | | $1,644.95 | $1,768.76 | $1,768.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.76 / $1,768.76 / $1,768.76
| Professional | | $1,768.76 | $1,768.76 | $1,768.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.39 / $1,540.39 / $1,540.39
| Facility | | $1,540.39 | $1,540.39 | $1,540.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.48 / $1,124.48 / $1,540.39
| Professional | | $1,124.48 | $1,124.48 | $1,540.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $2,123.00 / $4,776.75
| Facility | | $319.00 | $2,123.00 | $4,776.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.74 / $1,571.02 / $3,821.40
| Professional | | $1,227.74 | $1,571.02 | $3,821.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.67 / $1,534.67 / $1,534.67
| Facility | | $1,534.67 | $1,534.67 | $1,534.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.35 / $1,356.14 / $1,768.76
| Professional | | $1,276.35 | $1,356.14 | $1,768.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $1,540.39 / $2,123.00
| Facility | | $597.00 | $1,540.39 | $2,123.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.48 / $1,312.11 / $3,151.88
| Professional | | $1,124.48 | $1,312.11 | $3,151.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.09 / $1,102.21 / $1,943.11
| Professional | | $706.09 | $1,102.21 | $1,943.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.82 / $1,276.35 / $1,276.35
| Facility | | $1,134.82 | $1,276.35 | $1,276.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.35 / $1,276.35 / $1,534.67
| Professional | | $1,276.35 | $1,276.35 | $1,534.67 |