- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.62 / $1,976.30 / $7,920.26
| Facility | | $1,470.62 | $1,976.30 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.02 / $920.63 / $2,088.46
| Professional | | $675.02 | $920.63 | $2,088.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $736.00 / $736.00
| Facility | | $736.00 | $736.00 | $736.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.33 / $1,541.68 / $2,216.17
| Professional | | $960.33 | $1,541.68 | $2,216.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.36 / $1,683.66 / $1,962.49
| Professional | | $1,303.36 | $1,683.66 | $1,962.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.78 / $1,385.89 / $2,063.16
| Facility | | $948.78 | $1,385.89 | $2,063.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.40 / $1,405.81 / $2,033.07
| Professional | | $1,142.40 | $1,405.81 | $2,033.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.90 / $1,547.80 / $1,719.89
| Facility | | $1,025.90 | $1,547.80 | $1,719.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.78 / $1,470.02 / $2,443.58
| Facility | | $948.78 | $1,470.02 | $2,443.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,240.47 / $1,572.73 / $2,129.78
| Professional | | $1,240.47 | $1,572.73 | $2,129.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,671.70 / $18,246.18 / $21,922.68
| Facility | | $13,671.70 | $18,246.18 | $21,922.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.92 / $1,633.96 / $2,268.04
| Professional | | $1,249.92 | $1,633.96 | $2,268.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,268.00 / $24,231.00
| Facility | | $2,912.00 | $16,268.00 | $24,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.50 / $1,705.32 / $2,512.94
| Professional | | $1,182.50 | $1,705.32 | $2,512.94 |