- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.85 / $1,905.66 / $8,229.00
| Facility | | $1,805.85 | $1,905.66 | $8,229.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.03 / $1,863.25 / $2,306.48
| Professional | | $1,718.03 | $1,863.25 | $2,306.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.49 / $1,533.48 / $2,470.33
| Professional | | $1,265.49 | $1,533.48 | $2,470.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,767.07 / $2,425.39 / $2,797.86
| Facility | | $1,767.07 | $2,425.39 | $2,797.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,693.44 / $2,425.39 / $3,464.84
| Professional | | $1,693.44 | $2,425.39 | $3,464.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.71 / $2,130.71 / $2,130.71
| Facility | | $2,130.71 | $2,130.71 | $2,130.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.78 / $2,227.92 / $3,573.57
| Professional | | $1,601.78 | $2,227.92 | $3,573.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,905.66
| Professional | | $32.34 | $32.34 | $1,905.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.50 / $2,241.63 / $3,656.22
| Professional | | $1,641.50 | $2,241.63 | $3,656.22 |