- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,841.37 / $2,747.00 / $7,920.26
| Facility | | $1,841.37 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.87 / $1,123.26 / $3,476.62
| Professional | | $934.87 | $1,123.26 | $3,476.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.05 / $2,055.12 / $2,741.66
| Professional | | $1,275.05 | $2,055.12 | $2,741.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.88 / $2,090.73 / $2,353.94
| Professional | | $1,465.88 | $2,090.73 | $2,353.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.87 / $1,772.04 / $2,594.46
| Facility | | $934.87 | $1,772.04 | $2,594.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.41 / $1,646.69 / $2,986.60
| Professional | | $1,423.41 | $1,646.69 | $2,986.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.33 / $1,753.05 / $1,867.96
| Facility | | $1,291.33 | $1,753.05 | $1,867.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.87 / $2,009.97 / $2,382.09
| Facility | | $934.87 | $2,009.97 | $2,382.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,624.82 / $2,180.52 / $2,761.29
| Professional | | $1,624.82 | $2,180.52 | $2,761.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,858.66 / $4,858.66 / $4,858.66
| Facility | | $4,858.66 | $4,858.66 | $4,858.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,707.32 / $2,287.55 / $2,924.61
| Professional | | $1,707.32 | $2,287.55 | $2,924.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $7,664.00 / $36,803.00
| Facility | | $2,364.00 | $7,664.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,421.16 / $2,149.55 / $2,953.39
| Professional | | $1,421.16 | $2,149.55 | $2,953.39 |