- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,311.31 / $8,511.38
| Facility | | $1,148.15 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $3,715.35
| Professional | | $1,479.11 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $23,988.33 / $45,708.82
| Facility | | $8,912.51 | $23,988.33 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,090.30 / $3,388.44
| Professional | | $2,344.23 | $3,090.30 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,630.27 / $3,890.45
| Professional | | $1,548.82 | $2,630.27 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,884.03 / $6,918.31
| Professional | | $1,778.28 | $2,884.03 | $6,918.31 |
- 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
- $1,905.46 / $2,290.87 / $2,630.27
| Professional | | $1,905.46 | $2,290.87 | $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
- $1,698.24 / $2,290.87 / $3,981.07
| Professional | | $1,698.24 | $2,290.87 | $3,981.07 |