- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,548.13 / $9,772.37
| Facility | | $1,148.15 | $3,548.13 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,238.72 / $6,309.57
| Professional | | $1,778.28 | $2,238.72 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $21,379.62 / $40,738.03
| Facility | | $7,943.28 | $21,379.62 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,691.53 / $3,090.30
| Professional | | $2,238.72 | $2,691.53 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,818.38 / $4,073.80
| Professional | | $1,995.26 | $2,818.38 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,019.95 / $12,882.50
| Professional | | $1,778.28 | $3,019.95 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,344.23 / $2,630.27
| Professional | | $1,995.26 | $2,344.23 | $2,630.27 |
- 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
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,630.27 / $4,265.80
| Professional | | $1,905.46 | $2,630.27 | $4,265.80 |