- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,606.78 / $2,747.00 / $7,920.26
| Facility | | $1,606.78 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.37 / $1,065.13 / $4,210.93
| Professional | | $846.37 | $1,065.13 | $4,210.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.11 / $1,648.66 / $2,367.98
| Professional | | $1,097.11 | $1,648.66 | $2,367.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,253.11 / $1,766.47 / $2,010.89
| Professional | | $1,253.11 | $1,766.47 | $2,010.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.05 / $1,523.14 / $2,290.03
| Facility | | $766.05 | $1,523.14 | $2,290.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.93 / $1,835.75 / $2,562.23
| Professional | | $1,288.93 | $1,835.75 | $2,562.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,111.73 / $1,526.52 / $1,649.00
| Facility | | $1,111.73 | $1,526.52 | $1,649.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.05 / $1,661.07 / $2,290.03
| Facility | | $766.05 | $1,661.07 | $2,290.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.17 / $1,916.54 / $2,481.27
| Professional | | $1,409.17 | $1,916.54 | $2,481.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,328.10 / $4,328.10 / $4,328.10
| Facility | | $4,328.10 | $4,328.10 | $4,328.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.61 / $1,949.12 / $2,567.51
| Professional | | $1,481.61 | $1,949.12 | $2,567.51 |
- 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
- $1,251.65 / $1,856.56 / $2,539.08
| Professional | | $1,251.65 | $1,856.56 | $2,539.08 |