- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,696.97 / $3,632.65 / $5,916.03
| Facility | | $1,696.97 | $3,632.65 | $5,916.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.31 / $1,131.31 / $1,764.43
| Professional | | $1,131.31 | $1,131.31 | $1,764.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.34 / $17.85 / $1,428.15
| Professional | | $12.34 | $17.85 | $1,428.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,490.96 / $4,385.13 / $7,472.43
| Facility | | $2,490.96 | $4,385.13 | $7,472.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,385.08 / $2,981.34 / $10,005.36
| Professional | | $2,385.08 | $2,981.34 | $10,005.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $2,698.54 / $4,670.55
| Facility | | $319.00 | $2,698.54 | $4,670.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.32 / $2,036.98 / $5,770.72
| Professional | | $830.32 | $2,036.98 | $5,770.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,270.39 / $1,972.01 / $2,494.94
| Professional | | $1,270.39 | $1,972.01 | $2,494.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $4,385.13 / $7,472.43
| Facility | | $597.00 | $4,385.13 | $7,472.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,349.27 / $2,075.80 / $4,276.14
| Professional | | $1,349.27 | $2,075.80 | $4,276.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.84 / $1,245.48 / $3,048.79
| Professional | | $871.84 | $1,245.48 | $3,048.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,193.84 / $2,387.12 / $2,387.12
| Facility | | $2,193.84 | $2,387.12 | $2,387.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,270.39 / $2,075.80 / $2,494.94
| Professional | | $1,270.39 | $2,075.80 | $2,494.94 |