- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,546.79 / $2,747.00 / $7,920.26
| Facility | | $1,546.79 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.05 / $1,015.84 / $2,436.23
| Professional | | $690.05 | $1,015.84 | $2,436.23 |
- 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
- $785.29 / $1,465.09 / $2,181.50
| Professional | | $785.29 | $1,465.09 | $2,181.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.72 / $1,623.93 / $1,992.50
| Professional | | $1,236.72 | $1,623.93 | $1,992.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.84 / $1,394.13 / $2,116.85
| Facility | | $839.84 | $1,394.13 | $2,116.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.86 / $1,376.70 / $2,319.27
| Professional | | $1,151.86 | $1,376.70 | $2,319.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.65 / $1,478.02 / $1,581.87
| Facility | | $1,041.65 | $1,478.02 | $1,581.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.70 / $1,554.86 / $2,116.85
| Facility | | $853.70 | $1,554.86 | $2,116.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.68 / $1,703.03 / $2,222.96
| Professional | | $1,287.68 | $1,703.03 | $2,222.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,973.19 / $3,973.19 / $3,973.19
| Facility | | $3,973.19 | $3,973.19 | $3,973.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.94 / $1,842.70 / $2,227.57
| Professional | | $1,445.94 | $1,842.70 | $2,227.57 |
- 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
- $1,143.42 / $1,636.66 / $2,453.81
| Professional | | $1,143.42 | $1,636.66 | $2,453.81 |