- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.21 / $2,009.41 / $7,439.00
| Facility | | $1,227.21 | $2,009.41 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.32 / $1,246.63 / $2,407.01
| Professional | | $1,141.32 | $1,246.63 | $2,407.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,474.86 / $3,474.86 / $3,525.56
| Facility | | $3,474.86 | $3,474.86 | $3,525.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.49 / $2,071.83 / $3,138.14
| Professional | | $1,450.49 | $2,071.83 | $3,138.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $5,006.99
| Facility | | $530.04 | $530.04 | $5,006.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,340.26 / $1,828.54 / $3,260.58
| Professional | | $1,340.26 | $1,828.54 | $3,260.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.21 / $1,540.63 / $2,411.60
| Facility | | $1,227.21 | $1,540.63 | $2,411.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $1,651.00 / $1,651.00
| Professional | | $507.00 | $1,651.00 | $1,651.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,569.20 / $3,455.80
| Professional | | $5.00 | $1,569.20 | $3,455.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.82 / $1,497.17 / $3,185.92
| Professional | | $1,100.82 | $1,497.17 | $3,185.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,723.36 / $16,394.00 / $16,547.20
| Facility | | $6,723.36 | $16,394.00 | $16,547.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,976.00 / $9,976.00 / $10,130.40
| Professional | | $9,976.00 | $9,976.00 | $10,130.40 |