- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.03 / $2,747.00 / $7,920.26
| Facility | | $1,864.03 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.01 / $1,212.68 / $4,905.80
| Professional | | $939.01 | $1,212.68 | $4,905.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.15 / $2,008.51 / $2,732.81
| Professional | | $1,290.15 | $2,008.51 | $2,732.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,492.37 / $2,126.73 / $2,394.48
| Professional | | $1,492.37 | $2,126.73 | $2,394.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.68 / $1,891.17 / $2,607.26
| Facility | | $1,212.68 | $1,891.17 | $2,607.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.56 / $1,668.48 / $2,969.65
| Professional | | $1,490.56 | $1,668.48 | $2,969.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.42 / $1,746.23 / $1,861.93
| Facility | | $1,315.42 | $1,746.23 | $1,861.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.68 / $2,037.38 / $2,495.42
| Facility | | $1,212.68 | $2,037.38 | $2,495.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.06 / $2,136.06 / $2,731.45
| Professional | | $1,644.06 | $2,136.06 | $2,731.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,911.89 / $4,911.89 / $4,911.89
| Facility | | $4,911.89 | $4,911.89 | $4,911.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,688.87 / $2,280.17 / $2,915.17
| Professional | | $1,688.87 | $2,280.17 | $2,915.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $7,664.00 / $36,803.00
| Facility | | $2,364.00 | $7,664.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.71 / $1,985.47 / $2,921.46
| Professional | | $1,397.71 | $1,985.47 | $2,921.46 |