- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,188.44 / $3,715.22 / $7,209.02
| Facility | | $2,188.44 | $3,715.22 | $7,209.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,802.26 / $2,111.21 / $2,317.19
| Professional | | $1,802.26 | $2,111.21 | $2,317.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,012.34 / $3,604.51 / $4,557.13
| Facility | | $3,012.34 | $3,604.51 | $4,557.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,295.55 / $4,800.00 / $10,041.14
| Facility | | $3,295.55 | $4,800.00 | $10,041.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $1,861.47 / $7,260.51
| Facility | | $92.60 | $1,861.47 | $7,260.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.46 / $1,673.52 / $4,184.64
| Professional | | $1,171.46 | $1,673.52 | $4,184.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,574.65 / $2,574.65 / $3,913.47
| Professional | | $2,574.65 | $2,574.65 | $3,913.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.44 / $2,574.65 / $2,574.65
| Professional | | $2,188.44 | $2,574.65 | $2,574.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,534.89 / $4,800.00 / $4,824.00
| Professional | | $2,534.89 | $4,800.00 | $4,824.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.79 / $1,544.79 / $2,188.44
| Professional | | $1,544.79 | $1,544.79 | $2,188.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.28 / $3,993.62 / $8,006.88
| Facility | | $1,982.28 | $3,993.62 | $8,006.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,135.82 / $3,137.97 / $3,922.46
| Professional | | $3,135.82 | $3,137.97 | $3,922.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,445.92 / $2,445.92 / $3,089.58
| Facility | | $2,445.92 | $2,445.92 | $3,089.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.34 / $1,544.79 / $2,960.85
| Professional | | $1,081.34 | $1,544.79 | $2,960.85 |