- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,801.89 / $6,165.95
| Facility | | $1,737.80 | $3,801.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,621.81 / $2,137.96
| Professional | | $1,230.27 | $1,621.81 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $1,318.26
| Professional | | $302.00 | $302.00 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,235.94 / $7,585.78
| Facility | | $1,318.26 | $3,235.94 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $9,772.37 / $9,772.37
| Professional | | $2,041.74 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,311.31 / $7,762.47
| Facility | | $2,041.74 | $3,311.31 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,630.27 / $3,981.07
| Professional | | $2,137.96 | $2,630.27 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,995.26 / $3,630.78
| Professional | | $1,737.80 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,801.89 / $50,118.72
| Facility | | $2,630.27 | $3,801.89 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,089.30
| Professional | | $2,041.74 | $2,041.74 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,454.71
| Facility | | $1,819.70 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,691.53
| Professional | | $851.14 | $1,230.27 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,089.30 / $2,344.23
| Facility | | $1,230.27 | $2,089.30 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,041.74 / $3,981.07
| Professional | | $1,737.80 | $2,041.74 | $3,981.07 |