- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.71 / $352.28 / $7,920.26
| Facility | | $166.71 | $352.28 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,073.71 / $3,079.64 / $8,467.32
| Professional | | $2,073.71 | $3,079.64 | $8,467.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,114.88 / $4,231.74 / $6,089.93
| Professional | | $2,114.88 | $4,231.74 | $6,089.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,466.53 / $4,551.87 / $5,651.47
| Professional | | $3,466.53 | $4,551.87 | $5,651.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.98 / $3,907.73 / $6,149.69
| Facility | | $2,296.98 | $3,907.73 | $6,149.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,359.37 / $3,876.60 / $6,392.97
| Professional | | $3,359.37 | $3,876.60 | $6,392.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,179.46 / $4,360.35
| Facility | | $2,951.21 | $4,179.46 | $4,360.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.14 / $4,475.20 / $6,149.69
| Facility | | $2,347.14 | $4,475.20 | $6,149.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,714.03 / $4,709.97 / $6,073.94
| Professional | | $3,714.03 | $4,709.97 | $6,073.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,465.28 / $11,465.28 / $11,465.28
| Facility | | $11,465.28 | $11,465.28 | $11,465.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,014.30 / $5,079.49 / $6,184.33
| Professional | | $4,014.30 | $5,079.49 | $6,184.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,119.00 / $4,469.54 / $6,761.98
| Professional | | $3,119.00 | $4,469.54 | $6,761.98 |