- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.06 / $13,042.97 / $59,023.00
| Facility | | $1,682.06 | $13,042.97 | $59,023.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.52 / $1,055.08 / $2,814.50
| Professional | | $692.52 | $1,055.08 | $2,814.50 |
- 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
- $777.51 / $1,473.85 / $2,157.35
| Professional | | $777.51 | $1,473.85 | $2,157.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.24 / $1,607.54 / $1,971.26
| Professional | | $1,224.24 | $1,607.54 | $1,971.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.70 / $1,380.12 / $2,117.77
| Facility | | $844.70 | $1,380.12 | $2,117.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,168.92 / $1,368.85 / $2,295.69
| Professional | | $1,168.92 | $1,368.85 | $2,295.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.31 / $1,475.34 / $1,565.79
| Facility | | $1,087.31 | $1,475.34 | $1,565.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.30 / $1,556.36 / $2,117.77
| Facility | | $909.30 | $1,556.36 | $2,117.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,294.08 / $1,684.18 / $2,202.51
| Professional | | $1,294.08 | $1,684.18 | $2,202.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,669.04 / $6,435.12 / $12,850.27
| Facility | | $2,669.04 | $6,435.12 | $12,850.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,430.56 / $1,824.03 / $2,315.44
| Professional | | $1,430.56 | $1,824.03 | $2,315.44 |
- 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
- $1,131.00 / $1,583.41 / $2,409.75
| Professional | | $1,131.00 | $1,583.41 | $2,409.75 |