- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.06 / $2,747.00 / $7,920.26
| Facility | | $1,236.06 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.41 / $855.32 / $2,386.19
| Professional | | $588.41 | $855.32 | $2,386.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.79 / $1,201.07 / $1,699.85
| Professional | | $631.79 | $1,201.07 | $1,699.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.98 / $1,330.13 / $1,643.90
| Professional | | $1,012.98 | $1,330.13 | $1,643.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.76 / $1,142.04 / $1,739.20
| Facility | | $692.76 | $1,142.04 | $1,739.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.95 / $1,096.78 / $1,861.50
| Professional | | $950.95 | $1,096.78 | $1,861.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.32 / $1,185.23 / $1,269.65
| Facility | | $865.32 | $1,185.23 | $1,269.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $1,286.59 / $1,739.20
| Facility | | $737.00 | $1,286.59 | $1,739.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.76 / $1,350.11 / $1,734.03
| Professional | | $1,033.76 | $1,350.11 | $1,734.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,179.95 / $3,179.95 / $3,179.95
| Facility | | $3,179.95 | $3,179.95 | $3,179.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.49 / $1,471.47 / $1,783.20
| Professional | | $1,157.49 | $1,471.47 | $1,783.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.99 / $1,248.80 / $1,983.64
| Professional | | $890.99 | $1,248.80 | $1,983.64 |