- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.23 / $10,180.24 / $42,921.00
| Facility | | $2,080.23 | $10,180.24 | $42,921.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.27 / $1,304.99 / $3,508.00
| Professional | | $852.27 | $1,304.99 | $3,508.00 |
- 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
- $962.29 / $1,801.84 / $2,667.57
| Professional | | $962.29 | $1,801.84 | $2,667.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.48 / $1,989.96 / $2,441.37
| Professional | | $1,515.48 | $1,989.96 | $2,441.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.61 / $1,708.36 / $2,612.04
| Facility | | $1,044.61 | $1,708.36 | $2,612.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.05 / $1,679.94 / $2,841.87
| Professional | | $1,405.05 | $1,679.94 | $2,841.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.07 / $1,846.13 / $1,938.31
| Facility | | $1,342.07 | $1,846.13 | $1,938.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.41 / $1,907.34 / $2,612.04
| Facility | | $1,124.41 | $1,907.34 | $2,612.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.10 / $2,083.62 / $2,719.54
| Professional | | $1,563.10 | $2,083.62 | $2,719.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,763.99 / $12,680.11 / $13,092.93
| Facility | | $8,763.99 | $12,680.11 | $13,092.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.22 / $2,257.98 / $2,853.10
| Professional | | $1,768.22 | $2,257.98 | $2,853.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.00 / $11,770.00 / $26,404.00
| Facility | | $1,895.00 | $11,770.00 | $26,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.56 / $2,010.95 / $3,030.26
| Professional | | $1,368.56 | $2,010.95 | $3,030.26 |