- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.78 / $1,849.00 / $12,615.00
| Facility | | $1,237.78 | $1,849.00 | $12,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.08 / $1,237.78 / $1,369.52
| Professional | | $1,181.08 | $1,237.78 | $1,369.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.34 / $2,302.27 / $3,736.86
| Professional | | $1,485.34 | $2,302.27 | $3,736.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,330.42 / $7,330.42 / $7,330.42
| Professional | | $7,330.42 | $7,330.42 | $7,330.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.85 / $1,220.66 / $1,489.53
| Facility | | $1,201.85 | $1,220.66 | $1,489.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.85 / $1,201.85 / $1,587.00
| Professional | | $1,201.85 | $1,201.85 | $1,587.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $8.00 / $2,050.30
| Professional | | $8.00 | $8.00 | $2,050.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.33 / $1,885.45 / $3,476.41
| Professional | | $1,154.33 | $1,885.45 | $3,476.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,318.60 / $14,670.11 / $17,132.00
| Facility | | $9,318.60 | $14,670.11 | $17,132.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,865.60 / $10,620.90 / $10,620.90
| Professional | | $8,865.60 | $10,620.90 | $10,620.90 |