- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,002.09 / $4,683.26 / $9,006.27
| Facility | | $3,002.09 | $4,683.26 | $9,006.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,440.82 / $2,500.00
| Professional | | $1,500.00 | $2,440.82 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.50 / $4,405.57 / $11,708.15
| Facility | | $1,557.50 | $4,405.57 | $11,708.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,512.44 / $4,202.92 / $5,313.69
| Facility | | $3,512.44 | $4,202.92 | $5,313.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $2,170.51 / $8,465.89
| Facility | | $92.60 | $2,170.51 | $8,465.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,801.25 / $1,801.25 / $2,551.78
| Professional | | $1,801.25 | $1,801.25 | $2,551.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,551.78 / $3,002.09 / $3,002.09
| Professional | | $2,551.78 | $3,002.09 | $3,002.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.95 / $1,951.36 / $4,905.52
| Professional | | $1,365.95 | $1,951.36 | $4,905.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,002.09 / $3,002.09 / $4,563.18
| Professional | | $3,002.09 | $3,002.09 | $4,563.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.41 / $1,440.00 / $2,939.84
| Professional | | $1,176.41 | $1,440.00 | $2,939.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,653.85 / $5,024.75 / $8,781.12
| Facility | | $2,653.85 | $5,024.75 | $8,781.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,484.29 / $3,656.78 / $4,381.22
| Professional | | $3,484.29 | $3,656.78 | $4,381.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,701.88 / $2,701.88 / $2,701.88
| Facility | | $2,701.88 | $2,701.88 | $2,701.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.88 / $1,801.25 / $3,452.40
| Professional | | $1,260.88 | $1,801.25 | $3,452.40 |