- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.31 / $2,747.00 / $7,920.26
| Facility | | $1,025.31 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.76 / $693.20 / $1,633.80
| Professional | | $448.76 | $693.20 | $1,633.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.54 / $972.22 / $1,527.87
| Professional | | $602.54 | $972.22 | $1,527.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.08 / $1,124.34 / $1,346.34
| Professional | | $958.08 | $1,124.34 | $1,346.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.09 / $921.30 / $1,223.15
| Facility | | $611.09 | $921.30 | $1,223.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.79 / $916.36 / $1,386.88
| Professional | | $779.79 | $916.36 | $1,386.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.35 / $957.43 / $1,056.58
| Facility | | $692.35 | $957.43 | $1,056.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.51 / $935.82 / $1,343.78
| Facility | | $635.51 | $935.82 | $1,343.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.31 / $1,059.59 / $1,447.39
| Professional | | $876.31 | $1,059.59 | $1,447.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,585.50 / $2,585.50 / $2,585.50
| Facility | | $2,585.50 | $2,585.50 | $2,585.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.14 / $1,230.84 / $1,654.27
| Professional | | $963.14 | $1,230.84 | $1,654.27 |
- 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
- $720.96 / $1,036.39 / $1,622.36
| Professional | | $720.96 | $1,036.39 | $1,622.36 |