- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,595.19 / $3,310.02 / $5,371.37
| Facility | | $2,595.19 | $3,310.02 | $5,371.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.11 / $1,041.11 / $3,310.02
| Professional | | $1,041.11 | $1,041.11 | $3,310.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,443.55 / $5,697.75 / $7,195.32
| Facility | | $4,443.55 | $5,697.75 | $7,195.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.83 / $288.83 / $482.18
| Professional | | $288.83 | $288.83 | $482.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.16 / $1,395.16 / $2,720.56
| Professional | | $1,395.16 | $1,395.16 | $2,720.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.57 / $3,245.63 / $8,934.09
| Facility | | $1,133.57 | $3,245.63 | $8,934.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,124.11 / $2,124.11 / $2,544.92
| Professional | | $2,124.11 | $2,124.11 | $2,544.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.95 / $2,092.73 / $2,581.05
| Professional | | $1,743.95 | $2,092.73 | $2,581.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.99 / $1,514.36 / $2,092.73
| Facility | | $1,053.99 | $1,514.36 | $2,092.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.00 / $3,453.02 / $4,185.47
| Professional | | $1,380.00 | $3,453.02 | $4,185.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.26 / $1,743.95 / $3,226.31
| Facility | | $1,012.26 | $1,743.95 | $3,226.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.11 / $1,743.95 / $3,296.07
| Professional | | $905.11 | $1,743.95 | $3,296.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.46 / $732.46 / $732.46
| Facility | | $732.46 | $732.46 | $732.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.32 / $608.29 / $1,345.27
| Professional | | $491.32 | $608.29 | $1,345.27 |