- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.59 / $5,023.47 / $9,004.35
| Facility | | $2,211.59 | $5,023.47 | $9,004.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.49 / $2,077.32 / $2,685.51
| Professional | | $1,674.49 | $2,077.32 | $2,685.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $2,002.00
| Professional | | $500.00 | $500.00 | $2,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,791.30 / $6,674.27 / $11,373.42
| Facility | | $3,791.30 | $6,674.27 | $11,373.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,848.09 / $15,228.40 / $15,228.40
| Professional | | $3,848.09 | $15,228.40 | $15,228.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $3,791.30 / $7,108.70
| Facility | | $294.00 | $3,791.30 | $7,108.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,317.39 / $4,138.84 / $6,855.94
| Professional | | $3,317.39 | $4,138.84 | $6,855.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,685.51 / $3,120.35 / $5,728.96
| Professional | | $2,685.51 | $3,120.35 | $5,728.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $6,674.27 / $11,373.42
| Facility | | $597.00 | $6,674.27 | $11,373.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.62 / $3,412.17 / $7,266.67
| Professional | | $2,053.62 | $3,412.17 | $7,266.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $4,788.35
| Professional | | $1,326.96 | $1,895.65 | $4,788.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,226.45 / $3,633.26 / $3,633.26
| Facility | | $3,226.45 | $3,633.26 | $3,633.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,685.51 / $3,226.45 / $3,797.36
| Professional | | $2,685.51 | $3,226.45 | $3,797.36 |