- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,606.52 / $4,186.22 / $8,625.21
| Facility | | $2,606.52 | $4,186.22 | $8,625.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,211.59 / $2,559.13 / $2,843.48
| Professional | | $2,211.59 | $2,559.13 | $2,843.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $4,770.72 / $8,688.40
| Facility | | $97.00 | $4,770.72 | $8,688.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,696.52 / $4,423.18 / $5,592.17
| Facility | | $3,696.52 | $4,423.18 | $5,592.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $4,636.45 / $12,321.74
| Facility | | $1,050.00 | $4,636.45 | $12,321.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $550.00 / $2,622.31
| Professional | | $500.00 | $550.00 | $2,622.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,159.42 / $3,159.42
| Professional | | $3,159.42 | $3,159.42 | $3,159.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,159.42 / $4,802.32
| Professional | | $3,159.42 | $3,159.42 | $4,802.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.53 / $2,053.62 / $5,135.08
| Professional | | $1,437.53 | $2,053.62 | $5,135.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.65 / $1,895.65 / $2,685.51
| Professional | | $1,895.65 | $1,895.65 | $2,685.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,567.03 / $5,288.07 / $9,652.01
| Facility | | $2,567.03 | $5,288.07 | $9,652.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,848.09 / $3,848.09 / $4,610.43
| Professional | | $3,848.09 | $3,848.09 | $4,610.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.65 / $3,159.42 / $3,791.30
| Facility | | $1,895.65 | $3,159.42 | $3,791.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $3,633.33
| Professional | | $1,326.96 | $1,895.65 | $3,633.33 |