- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.98 / $3,066.00 / $7,799.00
| Facility | | $1,073.98 | $3,066.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.84 / $1,028.80 / $1,581.24
| Professional | | $928.84 | $1,028.80 | $1,581.24 |
- 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
- $1,028.23 / $1,067.03 / $1,907.62
| Professional | | $1,028.23 | $1,067.03 | $1,907.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.61 / $1,167.61 / $1,167.61
| Facility | | $1,167.61 | $1,167.61 | $1,167.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.39 / $1,164.04 / $2,030.70
| Professional | | $800.39 | $1,164.04 | $2,030.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.63 / $1,652.85 / $2,092.81
| Professional | | $1,211.63 | $1,652.85 | $2,092.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,839.00 / $8,017.00
| Facility | | $1,013.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.88 / $1,099.67 / $3,494.00
| Professional | | $931.88 | $1,099.67 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.80 / $1,135.80 / $2,117.50
| Professional | | $1,135.80 | $1,135.80 | $2,117.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.61 / $1,167.61 / $1,167.61
| Facility | | $1,167.61 | $1,167.61 | $1,167.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.02 / $1,228.85 / $2,086.91
| Professional | | $879.02 | $1,228.85 | $2,086.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.65 / $1,011.08 / $1,011.08
| Facility | | $964.65 | $1,011.08 | $1,011.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.65 / $1,011.08 / $1,068.02
| Professional | | $964.65 | $1,011.08 | $1,068.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.14 / $1,214.84 / $2,085.69
| Professional | | $827.14 | $1,214.84 | $2,085.69 |