- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.82 / $7,920.26 / $21,905.55
| Facility | | $1,658.82 | $7,920.26 | $21,905.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.49 / $1,018.20 / $2,375.69
| Professional | | $661.49 | $1,018.20 | $2,375.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.23 / $1,425.83 / $2,223.42
| Professional | | $892.23 | $1,425.83 | $2,223.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.26 / $1,644.84 / $1,973.34
| Professional | | $1,404.26 | $1,644.84 | $1,973.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.85 / $1,324.80 / $1,836.00
| Facility | | $987.85 | $1,324.80 | $1,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.68 / $1,297.20 / $1,995.62
| Professional | | $1,108.68 | $1,297.20 | $1,995.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $1,384.39 / $1,514.87
| Facility | | $969.00 | $1,384.39 | $1,514.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.85 / $1,365.86 / $1,932.44
| Facility | | $987.85 | $1,365.86 | $1,932.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.43 / $1,520.40 / $2,078.33
| Professional | | $1,292.43 | $1,520.40 | $2,078.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,382.73 / $9,212.20 / $12,052.68
| Facility | | $7,382.73 | $9,212.20 | $12,052.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.04 / $1,764.71 / $2,371.79
| Professional | | $1,385.04 | $1,764.71 | $2,371.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,786.00
| Facility | | $1,981.00 | $9,074.00 | $12,786.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.41 / $1,479.00 / $2,345.52
| Professional | | $1,030.41 | $1,479.00 | $2,345.52 |