- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.65 / $2,747.00 / $5,039.00
| Facility | | $1,352.65 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.10 / $965.49 / $2,456.52
| Professional | | $807.10 | $965.49 | $2,456.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $3,250.27 / $12,850.00
| Facility | | $1,591.00 | $3,250.27 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.77 / $1,633.02 / $6,737.20
| Professional | | $948.77 | $1,633.02 | $6,737.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.27 / $1,810.78 / $2,453.14
| Professional | | $1,104.27 | $1,810.78 | $2,453.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.76 / $1,592.82 / $2,678.85
| Professional | | $955.76 | $1,592.82 | $2,678.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.75 / $1,909.00 / $6,679.00
| Facility | | $932.75 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.33 / $1,296.52 / $1,771.90
| Professional | | $1,070.33 | $1,296.52 | $1,771.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,163.67 / $2,306.86 / $2,966.19
| Professional | | $1,163.67 | $2,306.86 | $2,966.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $33,500.00
| Facility | | $2,324.00 | $5,097.00 | $33,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.22 / $1,710.63 / $6,737.20
| Professional | | $1,018.22 | $1,710.63 | $6,737.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.70 / $1,409.65 / $2,730.66
| Professional | | $999.70 | $1,409.65 | $2,730.66 |