- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.33 / $2,747.00 / $7,920.26
| Facility | | $1,342.33 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.04 / $952.12 / $3,499.60
| Professional | | $618.04 | $952.12 | $3,499.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.04 / $1,492.02 / $2,010.03
| Professional | | $916.04 | $1,492.02 | $2,010.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.76 / $1,535.94 / $1,729.32
| Professional | | $1,071.76 | $1,535.94 | $1,729.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.12 / $1,383.18 / $2,047.06
| Facility | | $952.12 | $1,383.18 | $2,047.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.02 / $1,210.24 / $2,177.10
| Professional | | $1,021.02 | $1,210.24 | $2,177.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.63 / $1,235.83 / $1,369.48
| Facility | | $875.63 | $1,235.83 | $1,369.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.12 / $1,486.49 / $1,957.64
| Facility | | $952.12 | $1,486.49 | $1,957.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.33 / $1,581.06 / $2,019.24
| Professional | | $1,167.33 | $1,581.06 | $2,019.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,171.08 / $3,171.08 / $3,171.08
| Facility | | $3,171.08 | $3,171.08 | $3,171.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.51 / $1,677.10 / $2,144.16
| Professional | | $1,248.51 | $1,677.10 | $2,144.16 |
- 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
- $1,020.76 / $1,334.83 / $2,139.62
| Professional | | $1,020.76 | $1,334.83 | $2,139.62 |