- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.65 / $5,535.30 / $15,391.40
| Facility | | $1,895.65 | $5,535.30 | $15,391.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,769.28 / $2,085.21 / $2,527.54
| Professional | | $1,769.28 | $2,085.21 | $2,527.54 |
- 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
- $2,079.29 / $7,187.67 / $14,076.28
| Facility | | $2,079.29 | $7,187.67 | $14,076.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,848.09 / $3,848.09 / $4,610.43
| Professional | | $3,848.09 | $3,848.09 | $4,610.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,055.07 / $15,007.25 / $15,007.25
| Facility | | $5,055.07 | $15,007.25 | $15,007.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,733.91 / $15,733.91 / $23,695.65
| Professional | | $15,733.91 | $15,733.91 | $23,695.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.65 / $3,159.42 / $4,662.93
| Facility | | $1,895.65 | $3,159.42 | $4,662.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,159.42 / $3,949.28
| Professional | | $3,159.42 | $3,159.42 | $3,949.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.62 / $3,949.28 / $11,057.97
| Professional | | $2,053.62 | $3,949.28 | $11,057.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,053.62 / $3,162.57 / $9,544.19
| Facility | | $2,053.62 | $3,162.57 | $9,544.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.48 / $3,791.30 / $5,528.99
| Professional | | $2,843.48 | $3,791.30 | $5,528.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,326.96 / $2,022.03
| Professional | | $1,326.96 | $1,326.96 | $2,022.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.60 / $1,239.60 / $3,159.42
| Professional | | $1,239.60 | $1,239.60 | $3,159.42 |