- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,691.53 / $15,848.93
| Facility | | $2,041.74 | $2,691.53 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,174.90 / $2,570.40
| Professional | | $954.99 | $1,174.90 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $2,818.38
| Professional | | $1,096.48 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $2,511.89
| Professional | | $1,513.56 | $1,995.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $2,570.40
| Facility | | $1,000.00 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,862.09 / $2,691.53
| Professional | | $1,584.89 | $1,862.09 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,995.26 / $2,089.30
| Facility | | $1,621.81 | $1,995.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,290.87
| Facility | | $1,023.29 | $1,584.89 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,949.84 / $2,754.23
| Professional | | $79.43 | $1,949.84 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $22,387.21 / $27,542.29
| Facility | | $16,982.44 | $22,387.21 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,137.96 / $3,090.30
| Professional | | $1,862.09 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $31,622.78
| Facility | | $2,884.03 | $17,782.79 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $2,818.38
| Professional | | $1,348.96 | $1,995.26 | $2,818.38 |