- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,608.29 / $3,216.00 / $7,625.00
| Facility | | $1,608.29 | $3,216.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.88 / $1,113.18 / $1,802.95
| Professional | | $942.88 | $1,113.18 | $1,802.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.17 / $4,751.20 / $13,483.66
| Facility | | $1,224.17 | $4,751.20 | $13,483.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,060.78 / $1,847.28 / $8,014.80
| Professional | | $1,060.78 | $1,847.28 | $8,014.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.63 / $1,834.28 / $3,150.37
| Professional | | $1,112.63 | $1,834.28 | $3,150.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,111.01 / $1,909.00 / $6,679.00
| Facility | | $1,111.01 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.88 / $1,544.30 / $2,114.08
| Professional | | $1,274.88 | $1,544.30 | $2,114.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.63 / $2,742.91 / $3,618.33
| Professional | | $1,383.63 | $2,742.91 | $3,618.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.31 / $252.31 / $252.31
| Professional | | $252.31 | $252.31 | $252.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,063.00 / $13,773.00
| Facility | | $55.00 | $5,063.00 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.00 / $2,038.93 / $8,014.80
| Professional | | $1,172.00 | $2,038.93 | $8,014.80 |
- 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
- $1,098.45 / $1,708.56 / $3,244.05
| Professional | | $1,098.45 | $1,708.56 | $3,244.05 |