- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.45 / $2,747.00 / $7,920.26
| Facility | | $1,612.45 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.58 / $1,110.83 / $3,320.36
| Professional | | $737.58 | $1,110.83 | $3,320.36 |
- 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
- $836.42 / $1,559.58 / $2,272.41
| Professional | | $836.42 | $1,559.58 | $2,272.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.63 / $1,724.92 / $2,116.37
| Professional | | $1,313.63 | $1,724.92 | $2,116.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.44 / $1,566.79 / $2,349.16
| Facility | | $892.44 | $1,566.79 | $2,349.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.65 / $1,497.30 / $2,490.71
| Professional | | $1,231.65 | $1,497.30 | $2,490.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.17 / $1,591.92 / $1,641.50
| Facility | | $1,151.17 | $1,591.92 | $1,641.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.08 / $1,706.21 / $2,237.17
| Facility | | $957.08 | $1,706.21 | $2,237.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.48 / $1,783.38 / $2,327.14
| Professional | | $1,397.48 | $1,783.38 | $2,327.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,226.93 / $4,226.93 / $4,226.93
| Facility | | $4,226.93 | $4,226.93 | $4,226.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.82 / $1,912.23 / $2,321.38
| Professional | | $1,506.82 | $1,912.23 | $2,321.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.29 / $7,664.00 / $31,303.00
| Facility | | $1,035.29 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,206.16 / $1,673.00 / $2,557.14
| Professional | | $1,206.16 | $1,673.00 | $2,557.14 |