- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,398.83 / $7,943.28
| Facility | | $1,288.25 | $2,398.83 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $3,019.95
| Professional | | $1,000.00 | $1,288.25 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,238.72 / $2,951.21
| Professional | | $1,380.38 | $2,238.72 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $2,041.74 / $2,454.71
| Professional | | $912.01 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,862.09 / $2,818.38
| Facility | | $1,288.25 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,089.30 / $2,951.21
| Professional | | $1,621.81 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,905.46 / $2,137.96
| Facility | | $1,659.59 | $1,905.46 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $2,570.40
| Facility | | $1,148.15 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,862.09 / $2,754.23
| Professional | | $79.43 | $1,862.09 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,344.23 / $3,162.28
| Professional | | $1,819.70 | $2,344.23 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,238.72 / $2,951.21
| Professional | | $1,412.54 | $2,238.72 | $2,951.21 |