- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,365.16 / $6,025.60
| Facility | | $1,348.96 | $4,365.16 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,548.82 / $1,862.09
| Professional | | $1,288.25 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $9,120.11
| Facility | | $2,137.96 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $7,244.36
| Professional | | $1,174.90 | $1,949.84 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $3,090.30
| Facility | | $1,288.25 | $1,513.56 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,818.38
| Professional | | $2,344.23 | $2,344.23 | $2,818.38 |
- 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
- $2,818.38 / $2,818.38 / $3,311.31
| Professional | | $2,818.38 | $2,818.38 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $4,073.80
| Professional | | $1,949.84 | $1,949.84 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $9,120.11
| Facility | | $2,137.96 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $7,244.36
| Professional | | $1,174.90 | $1,949.84 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $2,344.23
| Facility | | $1,174.90 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $3,981.07
| Professional | | $1,174.90 | $1,949.84 | $3,981.07 |