- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,933.81 / $2,747.00 / $7,920.26
| Facility | | $1,933.81 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.25 / $1,324.82 / $3,362.35
| Professional | | $879.25 | $1,324.82 | $3,362.35 |
- 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
- $979.92 / $1,856.16 / $2,700.90
| Professional | | $979.92 | $1,856.16 | $2,700.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.53 / $2,030.73 / $2,485.96
| Professional | | $1,546.53 | $2,030.73 | $2,485.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.08 / $1,746.23 / $2,687.94
| Facility | | $1,054.08 | $1,746.23 | $2,687.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.40 / $1,762.66 / $2,879.19
| Professional | | $1,475.40 | $1,762.66 | $2,879.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.27 / $1,883.95 / $1,963.77
| Facility | | $1,318.27 | $1,883.95 | $1,963.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.27 / $1,977.57 / $2,687.94
| Facility | | $1,144.27 | $1,977.57 | $2,687.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.23 / $2,117.58 / $2,766.40
| Professional | | $1,645.23 | $2,117.58 | $2,766.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,068.06 / $5,068.06 / $5,068.06
| Facility | | $5,068.06 | $5,068.06 | $5,068.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,806.34 / $2,283.19 / $2,782.81
| Professional | | $1,806.34 | $2,283.19 | $2,782.81 |
- 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
- $1,394.05 / $1,978.99 / $3,095.61
| Professional | | $1,394.05 | $1,978.99 | $3,095.61 |