- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.67 / $3,254.21 / $9,025.96
| Facility | | $1,391.67 | $3,254.21 | $9,025.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.60 / $1,099.60 / $6,738.62
| Professional | | $1,099.60 | $1,099.60 | $6,738.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.95 / $1,743.95 / $1,743.95
| Professional | | $1,743.95 | $1,743.95 | $1,743.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.24 / $2,833.93 / $7,769.64
| Facility | | $779.24 | $2,833.93 | $7,769.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.99 / $2,124.11 / $2,544.92
| Professional | | $619.99 | $2,124.11 | $2,544.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,790.32 / $8,283.76 / $8,283.76
| Facility | | $2,790.32 | $8,283.76 | $8,283.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,684.87 / $8,684.87 / $13,079.63
| Professional | | $8,684.87 | $8,684.87 | $13,079.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.36 / $1,743.95 / $2,354.33
| Facility | | $1,046.36 | $1,743.95 | $2,354.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.75 / $1,778.83 / $2,615.92
| Professional | | $1,656.75 | $1,778.83 | $2,615.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.57 / $2,179.94 / $6,103.82
| Professional | | $1,133.57 | $2,179.94 | $6,103.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.44 / $1,795.57 / $4,815.29
| Facility | | $1,025.44 | $1,795.57 | $4,815.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.84 / $2,092.73 / $3,051.91
| Professional | | $935.84 | $2,092.73 | $3,051.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.32 / $491.32 / $831.18
| Professional | | $491.32 | $491.32 | $831.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.83 / $456.22 / $1,743.95
| Professional | | $288.83 | $456.22 | $1,743.95 |