- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.44 / $3,748.00 / $8,365.29
| Facility | | $906.44 | $3,748.00 | $8,365.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.20 / $1,003.69 / $1,831.62
| Professional | | $863.20 | $1,003.69 | $1,831.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.75 / $1,153.70 / $2,020.82
| Professional | | $1,111.75 | $1,153.70 | $2,020.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.02 / $1,153.70 / $1,992.02
| Professional | | $867.02 | $1,153.70 | $1,992.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.97 / $1,706.10 / $1,760.97
| Professional | | $1,326.97 | $1,706.10 | $1,760.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,872.49 / $8,207.41 / $15,057.45
| Facility | | $2,872.49 | $8,207.41 | $15,057.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.43 / $1,024.43 / $1,141.40
| Professional | | $1,024.43 | $1,024.43 | $1,141.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $4,068.00 / $8,017.00
| Facility | | $954.00 | $4,068.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.01 / $1,119.00 / $3,053.99
| Professional | | $873.01 | $1,119.00 | $3,053.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.00 / $1,106.00 / $1,161.50
| Professional | | $1,106.00 | $1,106.00 | $1,161.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,680.49 / $1,680.49 / $1,680.49
| Facility | | $1,680.49 | $1,680.49 | $1,680.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.15 / $1,158.07 / $2,107.19
| Professional | | $910.15 | $1,158.07 | $2,107.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.20 / $971.93 / $1,094.29
| Facility | | $863.20 | $971.93 | $1,094.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.01 / $1,027.90 / $1,162.58
| Professional | | $945.01 | $1,027.90 | $1,162.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,368.00
| Facility | | $1,440.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.43 / $1,181.76 / $2,134.59
| Professional | | $968.43 | $1,181.76 | $2,134.59 |