- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.03 / $4,048.00 / $8,451.00
| Facility | | $1,194.03 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.50 / $1,121.05 / $1,688.47
| Professional | | $999.50 | $1,121.05 | $1,688.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $25,716.00 / $39,341.64
| Facility | | $8,639.91 | $25,716.00 | $39,341.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.54 / $1,191.88 / $2,083.41
| Professional | | $1,148.54 | $1,191.88 | $2,083.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.43 / $1,303.43 / $1,303.43
| Facility | | $1,303.43 | $1,303.43 | $1,303.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.67 / $1,333.09 / $2,260.21
| Professional | | $940.67 | $1,333.09 | $2,260.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,382.40 / $1,938.39 / $2,387.79
| Professional | | $1,382.40 | $1,938.39 | $2,387.79 |
- 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
- $1,013.54 / $1,244.47 / $5,677.85
| Professional | | $1,013.54 | $1,244.47 | $5,677.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.50 / $1,126.50 / $2,308.80
| Professional | | $1,126.50 | $1,126.50 | $2,308.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.43 / $1,303.43 / $1,303.43
| Facility | | $1,303.43 | $1,303.43 | $1,303.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.84 / $1,347.22 / $2,283.21
| Professional | | $975.84 | $1,347.22 | $2,283.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.33 / $1,113.41 / $1,113.41
| Facility | | $925.33 | $1,113.41 | $1,113.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.33 / $1,113.41 / $1,187.56
| Professional | | $925.33 | $1,113.41 | $1,187.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $4,563.00 / $9,631.00
| Facility | | $2,468.00 | $4,563.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.95 / $1,338.20 / $2,283.80
| Professional | | $955.95 | $1,338.20 | $2,283.80 |