- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.33 / $2,815.06 / $5,045.87
| Facility | | $1,239.33 | $2,815.06 | $5,045.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.36 / $1,164.08 / $1,504.91
| Professional | | $938.36 | $1,164.08 | $1,504.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $33.20 / $92.96
| Professional | | $33.20 | $33.20 | $92.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,124.58 / $3,740.13 / $6,373.17
| Facility | | $2,124.58 | $3,740.13 | $6,373.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,156.50 / $8,533.70 / $8,533.70
| Professional | | $2,156.50 | $8,533.70 | $8,533.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $2,124.58 / $3,983.58
| Facility | | $294.00 | $2,124.58 | $3,983.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,859.00 / $2,319.33 / $3,841.94
| Professional | | $1,859.00 | $2,319.33 | $3,841.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,504.91 / $1,770.48 / $3,210.40
| Professional | | $1,504.91 | $1,770.48 | $3,210.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $3,740.13 / $6,373.17
| Facility | | $555.00 | $3,740.13 | $6,373.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.81 / $1,912.12 / $4,072.10
| Professional | | $1,150.81 | $1,912.12 | $4,072.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.60 / $1,062.29 / $2,683.30
| Professional | | $743.60 | $1,062.29 | $2,683.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,871.16 / $2,036.01 / $2,036.01
| Facility | | $1,871.16 | $2,036.01 | $2,036.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,504.91 / $1,871.16 / $2,134.88
| Professional | | $1,504.91 | $1,871.16 | $2,134.88 |