- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,606.69 / $2,747.00 / $7,920.26
| Facility | | $1,606.69 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.17 / $967.76 / $2,556.83
| Professional | | $644.17 | $967.76 | $2,556.83 |
- 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
- $835.48 / $1,517.17 / $2,228.29
| Professional | | $835.48 | $1,517.17 | $2,228.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.17 / $1,766.33 / $2,119.10
| Professional | | $1,495.17 | $1,766.33 | $2,119.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.94 / $1,379.95 / $1,790.42
| Facility | | $918.94 | $1,379.95 | $1,790.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.04 / $1,366.48 / $2,109.16
| Professional | | $1,124.04 | $1,366.48 | $2,109.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,390.25 / $1,624.75
| Facility | | $977.24 | $1,390.25 | $1,624.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.94 / $1,382.90 / $2,081.75
| Facility | | $918.94 | $1,382.90 | $2,081.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.96 / $1,602.36 / $2,226.88
| Professional | | $1,257.96 | $1,602.36 | $2,226.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,715.78 / $9,638.43 / $12,117.15
| Facility | | $7,715.78 | $9,638.43 | $12,117.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.36 / $1,892.71 / $2,543.83
| Professional | | $1,402.36 | $1,892.71 | $2,543.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,786.00
| Facility | | $1,981.00 | $9,074.00 | $12,786.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.25 / $1,482.04 / $2,385.42
| Professional | | $1,058.25 | $1,482.04 | $2,385.42 |