- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,669.00 / $5,270.00
| Facility | | $1,924.00 | $2,669.00 | $5,270.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.96 / $1,484.27 / $4,640.31
| Professional | | $1,298.96 | $1,484.27 | $4,640.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.74 / $4,809.60 / $13,073.36
| Facility | | $1,570.74 | $4,809.60 | $13,073.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.98 / $2,535.87 / $15,789.51
| Professional | | $1,402.98 | $2,535.87 | $15,789.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.40 / $2,342.38 / $4,123.52
| Professional | | $1,434.40 | $2,342.38 | $4,123.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.41 / $2,303.58 / $7,315.92
| Facility | | $1,424.41 | $2,303.58 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.51 / $1,979.93 / $2,702.87
| Professional | | $1,634.51 | $1,979.93 | $2,702.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.18 / $3,440.56 / $4,479.05
| Professional | | $1,757.18 | $3,440.56 | $4,479.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.82 / $0.82 / $0.82
| Facility | | $0.82 | $0.82 | $0.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,063.00 / $13,073.36
| Facility | | $55.00 | $5,063.00 | $13,073.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,551.39 / $2,623.10 / $15,789.51
| Professional | | $1,551.39 | $2,623.10 | $15,789.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,477.51 / $2,220.09 / $4,627.39
| Professional | | $1,477.51 | $2,220.09 | $4,627.39 |