- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.92 / $2,873.62 / $7,920.26
| Facility | | $2,320.92 | $2,873.62 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.33 / $1,287.22 / $3,690.63
| Professional | | $996.33 | $1,287.22 | $3,690.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.00 / $2,244.71 / $3,274.86
| Professional | | $1,191.00 | $2,244.71 | $3,274.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,874.64 / $2,461.57 / $3,015.35
| Professional | | $1,874.64 | $2,461.57 | $3,015.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.72 / $2,112.96 / $3,220.16
| Facility | | $1,295.72 | $2,112.96 | $3,220.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,097.79 / $3,517.71
| Professional | | $1,758.00 | $2,097.79 | $3,517.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.71 / $2,253.21 / $2,399.27
| Facility | | $1,549.71 | $2,253.21 | $2,399.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.22 / $2,365.19 / $3,220.16
| Facility | | $1,387.22 | $2,365.19 | $3,220.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,970.81 / $2,576.25 / $3,344.66
| Professional | | $1,970.81 | $2,576.25 | $3,344.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,068.92 / $6,068.92 / $6,068.92
| Facility | | $6,068.92 | $6,068.92 | $6,068.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,190.73 / $2,780.65 / $3,375.00
| Professional | | $2,190.73 | $2,780.65 | $3,375.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.57 / $2,359.80 / $3,704.31
| Professional | | $1,737.57 | $2,359.80 | $3,704.31 |