- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.61 / $4,050.00 / $9,534.00
| Facility | | $1,103.61 | $4,050.00 | $9,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.41 / $1,074.39 / $1,558.35
| Professional | | $956.41 | $1,074.39 | $1,558.35 |
- 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
- $1,065.71 / $1,123.25 / $1,946.46
| Professional | | $1,065.71 | $1,123.25 | $1,946.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.30 / $1,203.30 / $1,203.30
| Facility | | $1,203.30 | $1,203.30 | $1,203.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.03 / $1,288.38 / $2,144.51
| Professional | | $937.03 | $1,288.38 | $2,144.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.78 / $1,706.35 / $2,172.54
| Professional | | $1,257.78 | $1,706.35 | $2,172.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $5,342.00 / $10,510.00
| Facility | | $1,151.00 | $5,342.00 | $10,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.41 / $1,162.19 / $5,239.31
| Professional | | $956.41 | $1,162.19 | $5,239.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.90 / $1,257.90 / $2,166.80
| Professional | | $1,257.90 | $1,257.90 | $2,166.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.30 / $1,203.30 / $1,203.30
| Facility | | $1,203.30 | $1,203.30 | $1,203.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.30 / $1,319.29 / $2,206.61
| Professional | | $947.30 | $1,319.29 | $2,206.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,038.94 / $1,038.94 / $1,138.41
| Facility | | $1,038.94 | $1,038.94 | $1,138.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.23 / $1,045.88 / $1,138.41
| Professional | | $1,005.23 | $1,045.88 | $1,138.41 |
- 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
- $1,006.85 / $1,288.18 / $2,119.44
| Professional | | $1,006.85 | $1,288.18 | $2,119.44 |