- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.53 / $7,920.26 / $20,400.00
| Facility | | $2,059.53 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.53 / $1,241.39 / $2,648.55
| Professional | | $851.53 | $1,241.39 | $2,648.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.00 / $2,211.00 / $2,211.00
| Facility | | $2,211.00 | $2,211.00 | $2,211.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.97 / $1,959.99 / $3,060.28
| Professional | | $1,190.97 | $1,959.99 | $3,060.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,912.76 / $2,258.58 / $2,687.91
| Professional | | $1,912.76 | $2,258.58 | $2,687.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.09 / $1,970.18 / $2,814.75
| Facility | | $1,438.09 | $1,970.18 | $2,814.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.01 / $1,832.89 / $2,932.62
| Professional | | $1,659.01 | $1,832.89 | $2,932.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.25 / $2,014.69 / $2,085.04
| Facility | | $1,456.25 | $2,014.69 | $2,085.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.09 / $2,002.44 / $2,814.75
| Facility | | $1,438.09 | $2,002.44 | $2,814.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.33 / $2,104.90 / $2,857.75
| Professional | | $1,761.33 | $2,104.90 | $2,857.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,536.02 / $8,364.56 / $10,637.18
| Facility | | $6,536.02 | $8,364.56 | $10,637.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,888.76 / $2,428.92 / $3,264.49
| Professional | | $1,888.76 | $2,428.92 | $3,264.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,529.00 / $12,113.00
| Facility | | $1,981.00 | $9,529.00 | $12,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.35 / $2,119.92 / $3,236.85
| Professional | | $1,443.35 | $2,119.92 | $3,236.85 |