- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $5,495.41
| Facility | | $4,466.84 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,071.52
| Professional | | $537.03 | $724.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,025.60 / $12,882.50
| Facility | | $2,454.71 | $6,025.60 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $1,230.27
| Professional | | $1,023.29 | $1,202.26 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $977.24 / $1,174.90
| Professional | | $707.95 | $977.24 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,096.48 / $4,466.84
| Facility | | $562.34 | $1,096.48 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,047.13 / $1,258.93
| Professional | | $616.60 | $1,047.13 | $1,258.93 |
- 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
- $8,912.51 / $11,220.18 / $16,218.10
| Facility | | $8,912.51 | $11,220.18 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,000.00 / $1,202.26
| Professional | | $851.14 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,047.13 / $11,748.98
| Professional | | $501.19 | $1,047.13 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $16,982.44 / $18,197.01
| Facility | | $9,332.54 | $16,982.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $831.76 / $1,230.27
| Professional | | $588.84 | $831.76 | $1,230.27 |