- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.96 / $3,494.00 / $7,629.00
| Facility | | $937.96 | $3,494.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.38 / $937.96 / $2,401.85
| Professional | | $888.38 | $937.96 | $2,401.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.33 / $1,674.73 / $1,916.74
| Professional | | $1,025.33 | $1,674.73 | $1,916.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.60 / $1,184.45 / $2,061.28
| Professional | | $894.60 | $1,184.45 | $2,061.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.66 / $1,565.57 / $1,617.84
| Professional | | $1,217.66 | $1,565.57 | $1,617.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.47 / $7,732.91 / $11,401.55
| Facility | | $1,806.47 | $7,732.91 | $11,401.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.96 / $4,068.00 / $8,017.00
| Facility | | $937.96 | $4,068.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.86 / $1,071.88 / $3,494.00
| Professional | | $894.86 | $1,071.88 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.90 / $1,419.90 / $1,419.90
| Professional | | $1,419.90 | $1,419.90 | $1,419.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.46 / $1,161.46 / $1,161.46
| Facility | | $1,161.46 | $1,161.46 | $1,161.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.22 / $1,184.45 / $2,197.28
| Professional | | $947.22 | $1,184.45 | $2,197.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.23 / $1,005.23 / $1,160.01
| Facility | | $1,005.23 | $1,005.23 | $1,160.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.23 / $1,009.47 / $1,160.01
| Professional | | $1,005.23 | $1,009.47 | $1,160.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.98 / $1,150.83 / $2,073.04
| Professional | | $944.98 | $1,150.83 | $2,073.04 |