- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.52 / $2,747.00 / $7,920.26
| Facility | | $1,898.52 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.57 / $1,898.52 / $4,986.27
| Professional | | $1,010.57 | $1,898.52 | $4,986.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.11 / $2,103.57 / $2,850.82
| Professional | | $1,295.11 | $2,103.57 | $2,850.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,502.25 / $2,116.00 / $2,408.79
| Professional | | $1,502.25 | $2,116.00 | $2,408.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,255.68 / $1,958.23 / $2,832.34
| Facility | | $1,255.68 | $1,958.23 | $2,832.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,552.06 / $2,005.02 / $3,085.30
| Professional | | $1,552.06 | $2,005.02 | $3,085.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.60 / $1,830.01 / $1,970.47
| Facility | | $1,403.60 | $1,830.01 | $1,970.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,255.68 / $2,092.59 / $2,699.71
| Facility | | $1,255.68 | $2,092.59 | $2,699.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,662.96 / $2,260.44 / $2,971.55
| Professional | | $1,662.96 | $2,260.44 | $2,971.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,201.14 / $5,201.14 / $5,201.14
| Facility | | $5,201.14 | $5,201.14 | $5,201.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,774.36 / $2,334.25 / $3,074.83
| Professional | | $1,774.36 | $2,334.25 | $3,074.83 |
- 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
- $1,462.68 / $2,224.51 / $3,069.36
| Professional | | $1,462.68 | $2,224.51 | $3,069.36 |