- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,890.46 / $4,308.82 / $7,587.86
| Facility | | $1,890.46 | $4,308.82 | $7,587.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,436.27 / $1,625.97 / $2,303.46
| Professional | | $1,436.27 | $1,625.97 | $2,303.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $33.20 / $2,081.23
| Professional | | $33.20 | $33.20 | $2,081.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.47 / $3,804.78 / $9,465.35
| Facility | | $1,761.47 | $3,804.78 | $9,465.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,300.86 / $13,061.96 / $13,061.96
| Professional | | $3,300.86 | $13,061.96 | $13,061.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $3,522.94 / $6,097.39
| Facility | | $319.00 | $3,522.94 | $6,097.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,896.97 / $3,522.94 / $5,880.59
| Professional | | $1,896.97 | $3,522.94 | $5,880.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,303.46 / $2,676.44 / $4,913.93
| Professional | | $2,303.46 | $2,676.44 | $4,913.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $3,804.78 / $9,755.95
| Facility | | $597.00 | $3,804.78 | $9,755.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.47 / $2,953.85 / $6,232.89
| Professional | | $1,761.47 | $2,953.85 | $6,232.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,625.97 / $4,254.22
| Professional | | $1,138.18 | $1,625.97 | $4,254.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.95 / $3,116.38 / $3,116.38
| Facility | | $2,709.95 | $3,116.38 | $3,116.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,303.46 / $2,709.95 / $3,257.13
| Professional | | $2,303.46 | $2,709.95 | $3,257.13 |