- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.42 / $4,647.37 / $7,541.56
| Facility | | $1,836.42 | $4,647.37 | $7,541.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.00 / $1,909.88 / $2,361.19
| Professional | | $600.00 | $1,909.88 | $2,361.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,448.56 / $11,924.49
| Facility | | $2,448.56 | $2,448.56 | $11,924.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.42 / $979.42 / $1,493.62
| Professional | | $979.42 | $979.42 | $1,493.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,958.85 / $1,958.85 / $3,819.76
| Professional | | $1,958.85 | $1,958.85 | $3,819.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.56 / $4,557.50 / $12,543.92
| Facility | | $1,591.56 | $4,557.50 | $12,543.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.41 / $1,486.35 / $4,041.69
| Professional | | $939.41 | $1,486.35 | $4,041.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,938.27 / $3,623.87
| Professional | | $2,448.56 | $2,938.27 | $3,623.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.44 / $2,396.75 / $2,938.27
| Facility | | $798.44 | $2,396.75 | $2,938.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.00 / $2,545.41 / $5,782.68
| Professional | | $741.00 | $2,545.41 | $5,782.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.99 / $2,943.17 / $10,166.91
| Facility | | $1,713.99 | $2,943.17 | $10,166.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.99 / $2,943.17 / $10,166.91
| Professional | | $1,713.99 | $2,943.17 | $10,166.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.89 / $2,448.56 / $2,448.56
| Facility | | $541.89 | $2,448.56 | $2,448.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.88 / $1,028.40 / $1,469.14
| Professional | | $252.88 | $1,028.40 | $1,469.14 |