- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.78 / $7,920.26 / $15,978.56
| Facility | | $1,799.78 | $7,920.26 | $15,978.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.09 / $1,451.48 / $3,559.45
| Professional | | $939.09 | $1,451.48 | $3,559.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $1,184.00 / $1,184.00
| Facility | | $1,184.00 | $1,184.00 | $1,184.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.98 / $2,011.07 / $3,078.37
| Professional | | $1,177.98 | $2,011.07 | $3,078.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,952.83 / $2,287.40 / $2,744.22
| Professional | | $1,952.83 | $2,287.40 | $2,744.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.14 / $1,821.60 / $2,396.21
| Facility | | $1,229.14 | $1,821.60 | $2,396.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.80 / $1,807.44 / $2,788.61
| Professional | | $1,549.80 | $1,807.44 | $2,788.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.78 / $1,928.26 / $2,119.88
| Facility | | $1,349.78 | $1,928.26 | $2,119.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.77 / $2,023.56 / $7,090.00
| Facility | | $1,337.77 | $2,023.56 | $7,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,726.29 / $2,112.19 / $2,900.44
| Professional | | $1,726.29 | $2,112.19 | $2,900.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,715.78 / $10,171.54 / $12,117.15
| Facility | | $7,715.78 | $10,171.54 | $12,117.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,929.96 / $2,469.50 / $3,319.04
| Professional | | $1,929.96 | $2,469.50 | $3,319.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $5,130.00 / $7,385.00
| Facility | | $1,689.00 | $5,130.00 | $7,385.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.72 / $2,013.34 / $3,240.59
| Professional | | $1,379.72 | $2,013.34 | $3,240.59 |