- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.25 / $4,093.69 / $7,337.75
| Facility | | $1,802.25 | $4,093.69 | $7,337.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,364.56 / $1,692.83 / $2,188.44
| Professional | | $1,364.56 | $1,692.83 | $2,188.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $33.20 / $1,544.79
| Professional | | $33.20 | $33.20 | $1,544.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,089.58 / $5,438.94 / $9,269.20
| Facility | | $3,089.58 | $5,438.94 | $9,269.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,135.82 / $12,409.81 / $12,409.81
| Professional | | $3,135.82 | $12,409.81 | $12,409.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $1,012.43 / $5,792.96
| Facility | | $332.00 | $1,012.43 | $5,792.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,802.26 / $3,347.05 / $5,586.99
| Professional | | $1,802.26 | $3,347.05 | $5,586.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.44 / $2,574.65 / $4,668.60
| Professional | | $2,188.44 | $2,574.65 | $4,668.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $5,438.94 / $9,269.20
| Facility | | $597.00 | $5,438.94 | $9,269.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,673.52 / $2,780.62 / $5,921.70
| Professional | | $1,673.52 | $2,780.62 | $5,921.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.34 / $1,544.79 / $3,861.98
| Professional | | $1,081.34 | $1,544.79 | $3,861.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.28 / $2,960.78 / $2,960.78
| Facility | | $2,629.28 | $2,960.78 | $2,960.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.44 / $2,629.28 / $3,094.51
| Professional | | $2,188.44 | $2,629.28 | $3,094.51 |