- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.42 / $5,063.00 / $7,421.00
| Facility | | $1,939.42 | $5,063.00 | $7,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.84 / $1,564.35 / $3,295.16
| Professional | | $1,217.84 | $1,564.35 | $3,295.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.31 / $5,656.86 / $12,326.53
| Facility | | $2,206.31 | $5,656.86 | $12,326.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.79 / $2,085.12 / $3,865.28
| Professional | | $1,380.79 | $2,085.12 | $3,865.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,437.88 / $2,908.58 / $3,956.51
| Facility | | $2,437.88 | $2,908.58 | $3,956.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,570.90 / $57,200.00
| Facility | | $500.00 | $1,570.90 | $57,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.50 / $2,221.55 / $3,672.91
| Professional | | $1,468.50 | $2,221.55 | $3,672.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,587.91 / $2,333.54 / $4,258.82
| Professional | | $1,587.91 | $2,333.54 | $4,258.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.95 / $1,940.03 / $2,517.98
| Professional | | $1,337.95 | $1,940.03 | $2,517.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,998.00 / $9,193.00 / $18,613.00
| Facility | | $1,998.00 | $9,193.00 | $18,613.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,235.94 / $1,992.05 / $3,210.89
| Professional | | $1,235.94 | $1,992.05 | $3,210.89 |