- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.80 / $1,740.00 / $7,739.52
| Facility | | $1,426.80 | $1,740.00 | $7,739.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,218.00 / $1,392.00 / $1,740.00
| Professional | | $1,218.00 | $1,392.00 | $1,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $846.27
| Facility | | $846.27 | $846.27 | $846.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.32 / $846.27 / $846.27
| Professional | | $719.32 | $846.27 | $846.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $22,837.50 / $47,249.53
| Facility | | $2,088.00 | $22,837.50 | $47,249.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.00 / $2,436.00 / $32,273.00
| Professional | | $2,001.00 | $2,436.00 | $32,273.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.00 / $1,353.89 / $2,295.92
| Facility | | $1,131.00 | $1,353.89 | $2,295.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,019.33 / $8,386.79 / $8,386.79
| Professional | | $2,019.33 | $8,386.79 | $8,386.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.80 / $1,044.00 / $1,740.00
| Professional | | $730.80 | $1,044.00 | $1,740.00 |