- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.12 / $3,991.23 / $7,028.59
| Facility | | $1,751.12 | $3,991.23 | $7,028.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.41 / $1,650.46 / $2,133.67
| Professional | | $1,330.41 | $1,650.46 | $2,133.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $304.00 / $2,331.29
| Professional | | $0.03 | $304.00 | $2,331.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,631.64 / $3,524.34 / $8,768.20
| Facility | | $1,631.64 | $3,524.34 | $8,768.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,776.14 / $12,099.21 / $12,099.21
| Professional | | $2,776.14 | $12,099.21 | $12,099.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $3,263.27 / $5,647.97
| Facility | | $319.00 | $3,263.27 | $5,647.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.15 / $3,288.38 / $5,447.16
| Professional | | $1,757.15 | $3,288.38 | $5,447.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.67 / $2,479.17 / $4,551.75
| Professional | | $2,133.67 | $2,479.17 | $4,551.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $3,524.34 / $9,036.32
| Facility | | $597.00 | $3,524.34 | $9,036.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,631.64 / $2,736.13 / $5,773.48
| Professional | | $1,631.64 | $2,736.13 | $5,773.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,506.13 / $3,940.65
| Professional | | $1,054.29 | $1,506.13 | $3,940.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,886.68 / $2,886.68
| Facility | | $2,510.21 | $2,886.68 | $2,886.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.67 / $2,510.21 / $3,017.06
| Professional | | $2,133.67 | $2,510.21 | $3,017.06 |