- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.34 / $3,934.63 / $8,288.76
| Facility | | $1,200.34 | $3,934.63 | $8,288.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.02 / $1,187.72 / $1,225.61
| Professional | | $796.02 | $1,187.72 | $1,225.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.71 / $2,021.65 / $4,422.35
| Facility | | $1,326.71 | $2,021.65 | $4,422.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.18 / $3,114.62 / $9,476.48
| Professional | | $1,137.18 | $3,114.62 | $9,476.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.06 / $2,685.86 / $3,262.57
| Facility | | $1,314.06 | $2,685.86 | $3,262.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.18 / $1,263.53 / $3,158.82
| Facility | | $1,137.18 | $1,263.53 | $3,158.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.18 / $1,263.53 / $3,158.82
| Professional | | $1,137.18 | $1,263.53 | $3,158.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.53 / $1,263.53 / $1,768.94
| Facility | | $1,263.53 | $1,263.53 | $1,768.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.53 / $2,198.54 / $3,790.59
| Facility | | $1,263.53 | $2,198.54 | $3,790.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.18 / $1,579.41 / $1,907.93
| Professional | | $1,137.18 | $1,579.41 | $1,907.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.71 / $2,021.65 / $3,474.71
| Facility | | $1,326.71 | $2,021.65 | $3,474.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.46 / $2,469.21 / $3,095.07
| Professional | | $1,397.46 | $2,469.21 | $3,095.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.67 / $530.67 / $1,415.15
| Professional | | $530.67 | $530.67 | $1,415.15 |