- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,117.00
| Facility | | $2,528.00 | $2,894.76 | $6,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.27 / $1,637.54 / $2,201.89
| Professional | | $1,371.27 | $1,637.54 | $2,201.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $10,981.88
| Facility | | $1,672.00 | $5,268.00 | $10,981.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,175.83 / $1,940.08 / $10,031.04
| Professional | | $1,175.83 | $1,940.08 | $10,031.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.02 / $974.02 / $2,160.52
| Professional | | $974.02 | $974.02 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.39 / $2,434.23 / $4,440.46
| Professional | | $1,269.39 | $2,434.23 | $4,440.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.99 / $2,208.92 / $6,679.00
| Facility | | $1,366.99 | $2,208.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,510.52 / $1,877.58 / $2,591.79
| Professional | | $1,510.52 | $1,877.58 | $2,591.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,682.23 / $3,388.01 / $5,944.58
| Professional | | $1,682.23 | $3,388.01 | $5,944.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,348.21 / $2,348.21 / $2,348.21
| Professional | | $2,348.21 | $2,348.21 | $2,348.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,104.00 / $26,542.00
| Facility | | $2,155.00 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.16 / $1,988.28 / $10,031.04
| Professional | | $1,350.16 | $1,988.28 | $10,031.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.40 / $1,806.41 / $4,483.88
| Professional | | $1,296.40 | $1,806.41 | $4,483.88 |