- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.57 / $3,495.38 / $6,155.38
| Facility | | $1,533.57 | $3,495.38 | $6,155.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.13 / $1,319.01 / $1,868.60
| Professional | | $1,165.13 | $1,319.01 | $1,868.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $514.79 / $2,225.83
| Professional | | $514.79 | $514.79 | $2,225.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.93 / $3,086.49 / $7,678.09
| Facility | | $1,428.93 | $3,086.49 | $7,678.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,677.46 / $10,596.05 / $10,596.05
| Professional | | $2,677.46 | $10,596.05 | $10,596.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $2,857.86 / $4,946.29
| Facility | | $319.00 | $2,857.86 | $4,946.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.85 / $2,857.86 / $4,770.42
| Professional | | $1,538.85 | $2,857.86 | $4,770.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,868.60 / $2,171.17 / $3,986.25
| Professional | | $1,868.60 | $2,171.17 | $3,986.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $3,086.49 / $7,913.77
| Facility | | $597.00 | $3,086.49 | $7,913.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,428.93 / $2,396.19 / $5,056.21
| Professional | | $1,428.93 | $2,396.19 | $5,056.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.31 / $1,319.01 / $3,407.44
| Professional | | $923.31 | $1,319.01 | $3,407.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,198.35 / $2,528.05 / $2,528.05
| Facility | | $2,198.35 | $2,528.05 | $2,528.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,868.60 / $2,198.35 / $2,642.23
| Professional | | $1,868.60 | $2,198.35 | $2,642.23 |