- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,446.27 / $2,747.00 / $7,920.26
| Facility | | $1,446.27 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.21 / $980.02 / $3,775.79
| Professional | | $663.21 | $980.02 | $3,775.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.46 / $1,647.33 / $2,264.71
| Professional | | $1,021.46 | $1,647.33 | $2,264.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.93 / $1,720.35 / $1,936.94
| Professional | | $1,189.93 | $1,720.35 | $1,936.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.08 / $1,485.01 / $2,107.04
| Facility | | $964.08 | $1,485.01 | $2,107.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.38 / $1,312.13 / $2,459.31
| Professional | | $1,141.38 | $1,312.13 | $2,459.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.77 / $1,430.45 / $1,543.01
| Facility | | $1,003.77 | $1,430.45 | $1,543.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.02 / $1,633.20 / $2,061.31
| Facility | | $980.02 | $1,633.20 | $2,061.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.44 / $1,754.80 / $2,263.94
| Professional | | $1,297.44 | $1,754.80 | $2,263.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.33 / $3,877.33 / $3,877.33
| Facility | | $3,877.33 | $3,877.33 | $3,877.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,399.81 / $1,889.61 / $2,415.85
| Professional | | $1,399.81 | $1,889.61 | $2,415.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $8,571.00 / $36,803.00
| Facility | | $2,364.00 | $8,571.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.56 / $1,604.46 / $2,421.42
| Professional | | $1,140.56 | $1,604.46 | $2,421.42 |