- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,439.33 / $2,747.00 / $7,920.26
| Facility | | $1,439.33 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.84 / $953.79 / $3,771.80
| Professional | | $668.84 | $953.79 | $3,771.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.69 / $1,475.22 / $2,120.17
| Professional | | $981.69 | $1,475.22 | $2,120.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.00 / $1,581.09 / $1,799.87
| Professional | | $1,122.00 | $1,581.09 | $1,799.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.66 / $1,363.92 / $2,050.65
| Facility | | $685.66 | $1,363.92 | $2,050.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.42 / $1,644.18 / $2,294.85
| Professional | | $1,154.42 | $1,644.18 | $2,294.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.82 / $1,366.81 / $1,459.26
| Facility | | $1,007.82 | $1,366.81 | $1,459.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.66 / $1,487.44 / $2,050.65
| Facility | | $685.66 | $1,487.44 | $2,050.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.59 / $1,714.02 / $2,222.73
| Professional | | $1,287.59 | $1,714.02 | $2,222.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,866.73 / $3,866.73 / $3,866.73
| Facility | | $3,866.73 | $3,866.73 | $3,866.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.24 / $1,746.04 / $2,300.00
| Professional | | $1,327.24 | $1,746.04 | $2,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $7,664.00 / $36,803.00
| Facility | | $2,364.00 | $7,664.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.64 / $1,636.77 / $2,295.91
| Professional | | $1,121.64 | $1,636.77 | $2,295.91 |