- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,988.73 / $2,747.00 / $7,920.26
| Facility | | $1,988.73 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.71 / $1,027.31 / $5,213.46
| Professional | | $886.71 | $1,027.31 | $5,213.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,345.63 / $2,091.11 / $2,970.79
| Professional | | $1,345.63 | $2,091.11 | $2,970.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,577.10 / $2,242.90 / $2,553.25
| Professional | | $1,577.10 | $2,242.90 | $2,553.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.29 / $1,927.93 / $2,948.04
| Facility | | $1,329.29 | $1,927.93 | $2,948.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,619.29 / $2,088.21 / $3,218.96
| Professional | | $1,619.29 | $2,088.21 | $3,218.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.96 / $1,921.20 / $2,085.71
| Facility | | $1,422.96 | $1,921.20 | $2,085.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.29 / $2,093.78 / $2,857.97
| Facility | | $1,329.29 | $2,093.78 | $2,857.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,735.68 / $2,340.00 / $3,082.50
| Professional | | $1,735.68 | $2,340.00 | $3,082.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,525.92 / $5,525.92 / $5,525.92
| Facility | | $5,525.92 | $5,525.92 | $5,525.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.55 / $2,430.54 / $3,201.66
| Professional | | $1,847.55 | $2,430.54 | $3,201.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $26,100.00 / $51,981.00
| Facility | | $3,340.00 | $26,100.00 | $51,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.52 / $2,251.44 / $3,195.95
| Professional | | $1,534.52 | $2,251.44 | $3,195.95 |