- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,244.36 / $13,489.63
| Facility | | $1,584.89 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,412.54 / $3,235.94
| Professional | | $724.44 | $1,412.54 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,220.18 / $21,877.62
| Facility | | $8,709.64 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,202.26 / $1,737.80
| Professional | | $691.83 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,819.70 / $2,344.23
| Professional | | $812.83 | $1,819.70 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,621.81 / $8,912.51
| Facility | | $776.25 | $1,621.81 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $2,137.96
| Professional | | $1,000.00 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,819.70 / $2,344.23
| Professional | | $1,698.24 | $1,819.70 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $1,230.27 / $1,949.84
| Professional | | $3.02 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,079.46 / $9,120.11
| Facility | | $6,309.57 | $7,079.46 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $1,949.84
| Professional | | $1,047.13 | $1,548.82 | $1,949.84 |