- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.41 / $5,077.28 / $13,957.10
| Facility | | $1,457.41 | $5,077.28 | $13,957.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.05 / $1,612.86 / $1,651.73
| Professional | | $1,059.05 | $1,612.86 | $1,651.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $9,735.48
| Facility | | $244.00 | $614.00 | $9,735.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.40 / $1,378.08 / $3,186.86
| Professional | | $1,148.40 | $1,378.08 | $3,186.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $1,404.94 / $5,479.85
| Facility | | $92.60 | $1,404.94 | $5,479.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.16 / $1,263.08 / $3,158.36
| Professional | | $884.16 | $1,263.08 | $3,158.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.04 / $2,735.85 / $6,359.66
| Facility | | $1,282.04 | $2,735.85 | $6,359.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.21 / $2,331.85 / $3,109.14
| Professional | | $1,943.21 | $2,331.85 | $3,109.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.89 / $2,234.69 / $3,711.53
| Professional | | $1,748.89 | $2,234.69 | $3,711.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,381.19 / $9,230.25 / $9,230.25
| Facility | | $3,381.19 | $9,230.25 | $9,230.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,677.19 / $9,677.19 / $14,574.08
| Professional | | $9,677.19 | $9,677.19 | $14,574.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,554.57 / $2,331.85 / $5,155.93
| Facility | | $1,554.57 | $2,331.85 | $5,155.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.21 / $2,137.53 / $2,914.82
| Professional | | $1,943.21 | $2,137.53 | $2,914.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $874.44 / $5,414.95
| Professional | | $816.15 | $874.44 | $5,414.95 |