- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.83 / $3,852.84 / $6,274.62
| Facility | | $1,799.83 | $3,852.84 | $6,274.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.89 / $1,199.89 / $1,871.38
| Professional | | $1,199.89 | $1,199.89 | $1,871.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.34 / $21.48 / $1,514.71
| Professional | | $12.34 | $21.48 | $1,514.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,641.94 / $4,650.91 / $7,925.41
| Facility | | $2,641.94 | $4,650.91 | $7,925.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,529.63 / $3,162.03 / $10,611.81
| Professional | | $2,529.63 | $3,162.03 | $10,611.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $2,862.11 / $4,953.64
| Facility | | $319.00 | $2,862.11 | $4,953.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.65 / $2,160.69 / $6,120.50
| Professional | | $880.65 | $2,160.69 | $6,120.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.39 / $2,091.54 / $2,646.16
| Professional | | $1,347.39 | $2,091.54 | $2,646.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $4,650.91 / $7,925.41
| Facility | | $597.00 | $4,650.91 | $7,925.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.05 / $2,201.62 / $4,535.34
| Professional | | $1,431.05 | $2,201.62 | $4,535.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.68 / $1,320.97 / $3,412.51
| Professional | | $924.68 | $1,320.97 | $3,412.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.82 / $2,531.81 / $2,531.81
| Facility | | $2,326.82 | $2,531.81 | $2,531.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.39 / $2,201.62 / $2,646.16
| Professional | | $1,347.39 | $2,201.62 | $2,646.16 |