- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,416.28 / $7,920.26 / $20,400.00
| Facility | | $2,416.28 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.27 / $1,461.94 / $5,655.79
| Professional | | $999.27 | $1,461.94 | $5,655.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.92 / $2,473.21 / $3,391.68
| Professional | | $1,532.92 | $2,473.21 | $3,391.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,774.20 / $2,555.33 / $2,877.05
| Professional | | $1,774.20 | $2,555.33 | $2,877.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.94 / $2,229.62 / $3,143.17
| Facility | | $1,461.94 | $2,229.62 | $3,143.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,690.14 / $1,964.81 / $3,682.62
| Professional | | $1,690.14 | $1,964.81 | $3,682.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.93 / $2,129.92 / $2,310.83
| Facility | | $1,473.93 | $2,129.92 | $2,310.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.94 / $2,578.90 / $3,973.82
| Facility | | $1,461.94 | $2,578.90 | $3,973.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.24 / $2,632.89 / $3,391.68
| Professional | | $1,950.24 | $2,632.89 | $3,391.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,846.16 / $6,142.31 / $7,227.91
| Facility | | $4,846.16 | $6,142.31 | $7,227.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.94 / $2,829.90 / $3,618.00
| Professional | | $2,100.94 | $2,829.90 | $3,618.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,113.00
| Facility | | $1,981.00 | $9,074.00 | $12,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,687.41 / $2,536.12 / $3,634.29
| Professional | | $1,687.41 | $2,536.12 | $3,634.29 |