- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.72 / $4,642.16 / $8,320.86
| Facility | | $2,043.72 | $4,642.16 | $8,320.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.39 / $1,919.64 / $2,481.66
| Professional | | $1,547.39 | $1,919.64 | $2,481.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $208.00 / $6,598.30
| Professional | | $208.00 | $208.00 | $6,598.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,503.52 / $6,167.66 / $10,510.54
| Facility | | $3,503.52 | $6,167.66 | $10,510.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,556.09 / $14,072.47 / $14,072.47
| Professional | | $3,556.09 | $14,072.47 | $14,072.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $3,503.52 / $6,569.10
| Facility | | $294.00 | $3,503.52 | $6,569.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,065.58 / $3,824.68 / $6,335.53
| Professional | | $3,065.58 | $3,824.68 | $6,335.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,481.66 / $2,919.60 / $5,294.09
| Professional | | $2,481.66 | $2,919.60 | $5,294.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $6,167.66 / $10,510.54
| Facility | | $555.00 | $6,167.66 | $10,510.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.74 / $3,153.17 / $6,715.08
| Professional | | $1,897.74 | $3,153.17 | $6,715.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $4,525.38
| Professional | | $1,226.23 | $1,751.76 | $4,525.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.62 / $3,357.47 / $3,357.47
| Facility | | $3,085.62 | $3,357.47 | $3,357.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,481.66 / $3,085.62 / $3,520.51
| Professional | | $2,481.66 | $3,085.62 | $3,520.51 |