- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,570.40 / $13,803.84
| Facility | | $1,995.26 | $2,570.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,122.02 / $2,511.89
| Professional | | $912.01 | $1,122.02 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $2,754.23
| Professional | | $1,047.13 | $1,778.28 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,949.84 / $2,398.83
| Professional | | $1,479.11 | $1,949.84 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $2,691.53
| Facility | | $977.24 | $1,659.59 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,819.70 / $2,570.40
| Professional | | $1,513.56 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $2,041.74
| Facility | | $1,513.56 | $1,905.46 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $2,398.83
| Facility | | $1,000.00 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,905.46 / $2,691.53
| Professional | | $79.43 | $1,905.46 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $42,657.95 / $53,703.18
| Facility | | $33,884.42 | $42,657.95 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,041.74 / $2,951.21
| Professional | | $1,778.28 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $56,234.13
| Facility | | $2,884.03 | $17,782.79 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $2,691.53
| Professional | | $1,318.26 | $1,949.84 | $2,691.53 |