- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.00 / $4,250.00 / $10,398.00
| Facility | | $1,278.00 | $4,250.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.95 / $986.04 / $1,414.58
| Professional | | $876.95 | $986.04 | $1,414.58 |
- 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
- $977.56 / $1,050.67 / $1,781.30
| Professional | | $977.56 | $1,050.67 | $1,781.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.68 / $1,103.68 / $1,103.68
| Facility | | $1,103.68 | $1,103.68 | $1,103.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.23 / $1,198.90 / $1,967.22
| Professional | | $922.23 | $1,198.90 | $1,967.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.33 / $1,565.16 / $1,993.86
| Professional | | $1,154.33 | $1,565.16 | $1,993.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.00 / $5,350.00 / $11,083.00
| Facility | | $1,426.00 | $5,350.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.95 / $1,076.61 / $5,082.93
| Professional | | $876.95 | $1,076.61 | $5,082.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.40 / $1,226.40 / $1,987.10
| Professional | | $1,226.40 | $1,226.40 | $1,987.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.68 / $1,103.68 / $1,103.68
| Facility | | $1,103.68 | $1,103.68 | $1,103.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.23 / $1,210.66 / $2,018.62
| Professional | | $922.23 | $1,210.66 | $2,018.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.40 / $953.40 / $1,057.34
| Facility | | $953.40 | $953.40 | $1,057.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.86 / $959.35 / $1,057.34
| Professional | | $922.86 | $959.35 | $1,057.34 |
- 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
- $891.13 / $1,180.03 / $1,941.51
| Professional | | $891.13 | $1,180.03 | $1,941.51 |