- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.28 / $8,355.33 / $19,276.96
| Facility | | $724.28 | $8,355.33 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.85 / $1,004.26 / $3,460.85
| Professional | | $604.85 | $1,004.26 | $3,460.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.97 / $1,475.97 / $1,475.97
| Professional | | $1,475.97 | $1,475.97 | $1,475.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,104.22 / $6,659.73 / $12,985.98
| Facility | | $5,104.22 | $6,659.73 | $12,985.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.12 / $1,087.71 / $1,462.06
| Professional | | $638.12 | $1,087.71 | $1,462.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.00 / $1,539.00 / $1,539.00
| Facility | | $1,539.00 | $1,539.00 | $1,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.05 / $1,712.98 / $2,228.23
| Professional | | $1,443.05 | $1,712.98 | $2,228.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.28 / $1,155.90 / $4,572.72
| Facility | | $724.28 | $1,155.90 | $4,572.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.24 / $1,576.90 / $2,113.77
| Professional | | $1,070.24 | $1,576.90 | $2,113.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.67 / $1,678.30 / $2,071.71
| Facility | | $1,205.67 | $1,678.30 | $2,071.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.64 / $1,572.53 / $2,071.71
| Professional | | $1,157.64 | $1,572.53 | $2,071.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,356.00 / $7,772.00
| Facility | | $3,711.00 | $5,356.00 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.90 / $1,650.24 / $2,053.63
| Professional | | $1,166.90 | $1,650.24 | $2,053.63 |