- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.20 / $2,747.00 / $7,920.26
| Facility | | $1,514.20 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.21 / $1,046.23 / $2,749.10
| Professional | | $674.21 | $1,046.23 | $2,749.10 |
- 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
- $771.58 / $1,435.67 / $2,107.27
| Professional | | $771.58 | $1,435.67 | $2,107.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.39 / $1,595.91 / $1,959.37
| Professional | | $1,215.39 | $1,595.91 | $1,959.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $833.84 / $1,370.07 / $2,027.06
| Facility | | $833.84 | $1,370.07 | $2,027.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.48 / $1,325.53 / $2,277.03
| Professional | | $1,131.48 | $1,325.53 | $2,277.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.83 / $1,402.36 / $1,553.06
| Facility | | $1,036.83 | $1,402.36 | $1,553.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.02 / $1,520.96 / $2,027.06
| Facility | | $901.02 | $1,520.96 | $2,027.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.25 / $1,659.74 / $2,179.14
| Professional | | $1,251.25 | $1,659.74 | $2,179.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,779.75 / $3,779.75 / $3,779.75
| Facility | | $3,779.75 | $3,779.75 | $3,779.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.79 / $1,799.93 / $2,181.15
| Professional | | $1,415.79 | $1,799.93 | $2,181.15 |
- 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
- $1,091.92 / $1,544.23 / $2,402.65
| Professional | | $1,091.92 | $1,544.23 | $2,402.65 |