- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,480.23 / $3,310.02 / $5,371.37
| Facility | | $2,480.23 | $3,310.02 | $5,371.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.00 / $995.00 / $3,310.02
| Professional | | $995.00 | $995.00 | $3,310.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,246.05 / $5,444.51 / $6,875.52
| Facility | | $4,246.05 | $5,444.51 | $6,875.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $335.33 / $559.79
| Professional | | $335.33 | $335.33 | $559.79 |
- 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
- $1,007.30 / $1,451.84 / $2,068.26
| Facility | | $1,007.30 | $1,451.84 | $2,068.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.00 / $3,453.02 / $4,185.47
| Professional | | $1,319.00 | $3,453.02 | $4,185.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.27 / $1,743.95 / $3,226.31
| Facility | | $967.27 | $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
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $581.35 / $1,285.68
| Professional | | $469.55 | $581.35 | $1,285.68 |