- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $3,121.52 / $7,602.00
| Facility | | $1,821.00 | $3,121.52 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,322.68 / $1,750.21 / $2,022.16
| Professional | | $1,322.68 | $1,750.21 | $2,022.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,302.00 / $4,528.00
| Facility | | $1,275.00 | $2,302.00 | $4,528.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.35 / $1,580.21 / $2,714.17
| Professional | | $1,161.35 | $1,580.21 | $2,714.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.83 / $1,805.52 / $2,756.94
| Professional | | $1,326.83 | $1,805.52 | $2,756.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $20,222.04 / $20,682.59
| Facility | | $55.00 | $20,222.04 | $20,682.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,601.75 / $10,601.75 / $13,424.70
| Professional | | $10,601.75 | $10,601.75 | $13,424.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.58 / $1,898.12 / $3,201.52
| Professional | | $1,342.58 | $1,898.12 | $3,201.52 |