- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,202.26
| Professional | | $549.54 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,623.41 / $18,620.87
| Facility | | $2,290.87 | $5,623.41 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,148.15 / $1,202.26
| Professional | | $977.24 | $1,148.15 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,023.29
| Professional | | $588.84 | $812.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,000.00 / $1,548.82
| Facility | | $575.44 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,071.52 / $1,412.54
| Professional | | $933.25 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,218.10 / $22,908.68
| Facility | | $12,022.64 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $1,412.54
| Professional | | $812.83 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $11,220.18
| Professional | | $512.86 | $691.83 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $9,332.54 / $18,197.01
| Facility | | $1,513.56 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,202.26
| Professional | | $588.84 | $870.96 | $1,202.26 |