- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.25 / $2,962.52 / $5,310.18
| Facility | | $1,304.25 | $2,962.52 | $5,310.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.51 / $1,225.07 / $1,583.74
| Professional | | $987.51 | $1,225.07 | $1,583.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $208.00 / $6,347.46
| Professional | | $208.00 | $208.00 | $6,347.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,235.86 / $3,936.04 / $6,707.37
| Facility | | $2,235.86 | $3,936.04 | $6,707.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,269.44 / $8,980.71 / $8,980.71
| Professional | | $2,269.44 | $8,980.71 | $8,980.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $2,235.86 / $4,192.25
| Facility | | $294.00 | $2,235.86 | $4,192.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,956.38 / $2,440.82 / $4,043.19
| Professional | | $1,956.38 | $2,440.82 | $4,043.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,583.74 / $1,863.22 / $3,378.56
| Professional | | $1,583.74 | $1,863.22 | $3,378.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $3,936.04 / $6,707.37
| Facility | | $597.00 | $3,936.04 | $6,707.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.08 / $2,012.28 / $4,285.41
| Professional | | $1,211.08 | $2,012.28 | $4,285.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $1,117.93 / $2,924.98
| Professional | | $782.55 | $1,117.93 | $2,924.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,969.17 / $2,142.66 / $2,142.66
| Facility | | $1,969.17 | $2,142.66 | $2,142.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,583.74 / $1,969.17 / $2,246.71
| Professional | | $1,583.74 | $1,969.17 | $2,246.71 |