- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.88 / $2,747.00 / $7,920.26
| Facility | | $1,428.88 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.20 / $1,009.47 / $2,290.14
| Professional | | $667.20 | $1,009.47 | $2,290.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.26 / $1,418.30 / $2,089.63
| Professional | | $887.26 | $1,418.30 | $2,089.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.18 / $1,593.21 / $1,911.39
| Professional | | $1,360.18 | $1,593.21 | $1,911.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.00 / $1,385.28 / $1,788.65
| Facility | | $959.00 | $1,385.28 | $1,788.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.59 / $1,288.49 / $1,932.74
| Professional | | $1,134.59 | $1,288.49 | $1,932.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.99 / $1,348.93 / $1,462.61
| Facility | | $984.99 | $1,348.93 | $1,462.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.87 / $1,408.98 / $1,854.35
| Facility | | $928.87 | $1,408.98 | $1,854.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.24 / $1,460.56 / $1,996.76
| Professional | | $1,272.24 | $1,460.56 | $1,996.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,472.14 / $39,875.19 / $51,188.76
| Facility | | $18,472.14 | $39,875.19 | $51,188.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.08 / $1,703.83 / $2,289.96
| Professional | | $1,329.08 | $1,703.83 | $2,289.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $18,628.00 / $26,255.00
| Facility | | $3,028.00 | $18,628.00 | $26,255.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.96 / $1,415.88 / $2,238.79
| Professional | | $984.96 | $1,415.88 | $2,238.79 |