- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,420.08 / $12,274.80 / $59,023.00
| Facility | | $1,420.08 | $12,274.80 | $59,023.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.80 / $1,000.09 / $2,939.96
| Professional | | $685.80 | $1,000.09 | $2,939.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,250.41 / $3,250.41 / $5,022.74
| Facility | | $3,250.41 | $3,250.41 | $5,022.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.46 / $1,380.69 / $1,999.99
| Professional | | $681.46 | $1,380.69 | $1,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.08 / $1,485.21 / $1,847.92
| Professional | | $1,131.08 | $1,485.21 | $1,847.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.56 / $1,305.20 / $1,885.45
| Facility | | $763.56 | $1,305.20 | $1,885.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.96 / $1,257.59 / $2,077.62
| Professional | | $1,108.96 | $1,257.59 | $2,077.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.51 / $1,371.95 / $1,417.05
| Facility | | $1,015.51 | $1,371.95 | $1,417.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.69 / $1,513.99 / $2,436.83
| Facility | | $840.69 | $1,513.99 | $2,436.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,194.05 / $1,528.84 / $2,005.96
| Professional | | $1,194.05 | $1,528.84 | $2,005.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,671.70 / $19,116.02 / $21,922.68
| Facility | | $13,671.70 | $19,116.02 | $21,922.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.48 / $1,650.76 / $2,158.88
| Professional | | $1,296.48 | $1,650.76 | $2,158.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,151.00 / $15,055.00 / $24,231.00
| Facility | | $2,151.00 | $15,055.00 | $24,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.00 / $1,446.20 / $2,200.17
| Professional | | $1,043.00 | $1,446.20 | $2,200.17 |