- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,520.09 / $7,920.26 / $15,978.56
| Facility | | $1,520.09 | $7,920.26 | $15,978.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.03 / $1,769.63 / $3,642.61
| Professional | | $744.03 | $1,769.63 | $3,642.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.27 / $2,304.02 / $4,683.30
| Professional | | $1,181.27 | $2,304.02 | $4,683.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.91 / $1,932.32 / $3,843.91
| Professional | | $1,320.91 | $1,932.32 | $3,843.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.87 / $1,939.02 / $4,864.95
| Facility | | $901.87 | $1,939.02 | $4,864.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.33 / $2,266.37 / $4,687.97
| Professional | | $1,113.33 | $2,266.37 | $4,687.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.68 / $3,063.37 / $3,801.69
| Facility | | $1,318.68 | $3,063.37 | $3,801.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.25 / $3,164.95 / $7,013.00
| Facility | | $931.25 | $3,164.95 | $7,013.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.04 / $2,266.17 / $4,476.72
| Professional | | $1,316.04 | $2,266.17 | $4,476.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,927.24 / $16,067.82 / $19,370.28
| Facility | | $11,927.24 | $16,067.82 | $19,370.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.29 / $2,974.90 / $4,583.06
| Professional | | $1,323.29 | $2,974.90 | $4,583.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,268.00 / $24,231.00
| Facility | | $2,912.00 | $16,268.00 | $24,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,582.28 / $3,826.65 / $5,146.07
| Professional | | $2,582.28 | $3,826.65 | $5,146.07 |