- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,361.32 / $3,756.08 / $4,985.96
| Facility | | $3,361.32 | $3,756.08 | $4,985.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,854.62 / $3,756.08 / $4,985.96
| Professional | | $2,854.62 | $3,756.08 | $4,985.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.04 / $999.52 / $2,023.56
| Facility | | $517.04 | $999.52 | $2,023.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.51 / $407.99 / $407.99
| Professional | | $352.51 | $407.99 | $407.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,735.00 / $5,735.00 / $5,735.00
| Facility | | $5,735.00 | $5,735.00 | $5,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $3,417.67 / $4,884.46
| Facility | | $200.00 | $3,417.67 | $4,884.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.00 / $3,344.98 / $5,006.57
| Professional | | $462.00 | $3,344.98 | $5,006.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,589.84 / $21,533.82 / $22,318.92
| Facility | | $8,589.84 | $21,533.82 | $22,318.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.81 / $2,736.54 / $5,157.68
| Facility | | $500.81 | $2,736.54 | $5,157.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.62 / $2,327.08 / $6,128.68
| Professional | | $527.62 | $2,327.08 | $6,128.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.58 / $2,736.54 / $5,134.10
| Facility | | $536.58 | $2,736.54 | $5,134.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.00 / $2,327.08 / $3,344.98
| Professional | | $462.00 | $2,327.08 | $3,344.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,195.33 / $2,899.80 / $5,512.33
| Professional | | $2,195.33 | $2,899.80 | $5,512.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,255.45 / $4,327.68 / $4,327.68
| Professional | | $4,255.45 | $4,327.68 | $4,327.68 |