- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.85 / $4,048.00 / $8,451.00
| Facility | | $1,131.85 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.12 / $1,101.84 / $1,597.26
| Professional | | $981.12 | $1,101.84 | $1,597.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,850.00 / $16,455.00 / $26,582.19
| Facility | | $8,850.00 | $16,455.00 | $26,582.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.32 / $1,133.54 / $2,006.22
| Professional | | $1,092.32 | $1,133.54 | $2,006.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.82 / $1,234.82 / $1,234.82
| Facility | | $1,234.82 | $1,234.82 | $1,234.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.49 / $1,337.01 / $2,199.39
| Professional | | $1,030.49 | $1,337.01 | $2,199.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.66 / $1,747.80 / $2,225.87
| Professional | | $1,288.66 | $1,747.80 | $2,225.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.03 / $1,143.03 / $1,209.10
| Professional | | $1,143.03 | $1,143.03 | $1,209.10 |
- 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
- $981.12 / $1,224.40 / $5,372.46
| Professional | | $981.12 | $1,224.40 | $5,372.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.40 / $1,267.40 / $2,218.50
| Professional | | $1,267.40 | $1,267.40 | $2,218.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.82 / $1,234.82 / $1,234.82
| Facility | | $1,234.82 | $1,234.82 | $1,234.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.49 / $1,351.80 / $2,249.17
| Professional | | $1,030.49 | $1,351.80 | $2,249.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.54 / $1,065.54 / $1,208.72
| Facility | | $1,065.54 | $1,065.54 | $1,208.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.91 / $1,072.72 / $1,208.72
| Professional | | $1,030.91 | $1,072.72 | $1,208.72 |
- 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
- $999.03 / $1,318.91 / $2,062.42
| Professional | | $999.03 | $1,318.91 | $2,062.42 |