- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.45 / $4,048.00 / $8,451.00
| Facility | | $1,037.45 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.28 / $1,016.94 / $1,470.80
| Professional | | $907.28 | $1,016.94 | $1,470.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $26,582.19
| Facility | | $8,639.91 | $11,851.00 | $26,582.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.83 / $1,054.01 / $1,898.39
| Professional | | $1,005.83 | $1,054.01 | $1,898.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.56 / $1,134.56 / $1,134.56
| Facility | | $1,134.56 | $1,134.56 | $1,134.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.29 / $1,237.28 / $2,015.93
| Professional | | $957.29 | $1,237.28 | $2,015.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.64 / $1,562.49 / $2,034.10
| Professional | | $1,177.64 | $1,562.49 | $2,034.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $4,993.00 / $10,247.00
| Facility | | $1,151.00 | $4,993.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.28 / $1,057.96 / $5,420.33
| Professional | | $907.28 | $1,057.96 | $5,420.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.30 / $1,187.30 / $2,079.60
| Professional | | $1,187.30 | $1,187.30 | $2,079.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.56 / $1,134.56 / $1,134.56
| Facility | | $1,134.56 | $1,134.56 | $1,134.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.49 / $1,241.74 / $2,095.35
| Professional | | $959.49 | $1,241.74 | $2,095.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.23 / $987.23 / $1,260.38
| Facility | | $987.23 | $987.23 | $1,260.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.02 / $987.23 / $1,260.38
| Professional | | $964.02 | $987.23 | $1,260.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,879.00 / $7,508.00
| Facility | | $2,332.00 | $3,879.00 | $7,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.31 / $1,217.79 / $1,913.33
| Professional | | $914.31 | $1,217.79 | $1,913.33 |