- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.82 / $2,011.80 / $7,920.26
| Facility | | $1,787.82 | $2,011.80 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.26 / $963.98 / $2,083.77
| Professional | | $663.26 | $963.98 | $2,083.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.00 / $691.00 / $691.00
| Facility | | $691.00 | $691.00 | $691.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.19 / $1,386.20 / $2,325.54
| Professional | | $887.19 | $1,386.20 | $2,325.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.47 / $1,772.18 / $2,065.66
| Professional | | $898.47 | $1,772.18 | $2,065.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.23 / $1,392.63 / $2,125.17
| Facility | | $867.23 | $1,392.63 | $2,125.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.46 / $1,439.56 / $2,431.73
| Professional | | $1,196.46 | $1,439.56 | $2,431.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.99 / $1,608.03 / $1,776.17
| Facility | | $1,053.99 | $1,608.03 | $1,776.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.91 / $1,500.72 / $2,257.66
| Facility | | $922.91 | $1,500.72 | $2,257.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.83 / $1,661.31 / $2,236.35
| Professional | | $1,269.83 | $1,661.31 | $2,236.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,698.81 / $7,379.02 / $8,723.76
| Facility | | $5,698.81 | $7,379.02 | $8,723.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.15 / $1,703.31 / $2,315.28
| Professional | | $1,471.15 | $1,703.31 | $2,315.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,786.00
| Facility | | $1,981.00 | $9,074.00 | $12,786.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.80 / $1,625.21 / $2,364.10
| Professional | | $1,135.80 | $1,625.21 | $2,364.10 |