- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.94 / $4,048.00 / $8,451.00
| Facility | | $1,043.94 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.26 / $1,015.45 / $1,474.31
| Professional | | $904.26 | $1,015.45 | $1,474.31 |
- 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
- $1,008.24 / $1,066.29 / $1,837.36
| Professional | | $1,008.24 | $1,066.29 | $1,837.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,138.27 / $1,138.27 / $1,138.27
| Facility | | $1,138.27 | $1,138.27 | $1,138.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.82 / $1,230.19 / $2,028.55
| Professional | | $944.82 | $1,230.19 | $2,028.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.61 / $1,614.81 / $2,056.52
| Professional | | $1,190.61 | $1,614.81 | $2,056.52 |
- 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
- $904.26 / $1,094.43 / $4,958.87
| Professional | | $904.26 | $1,094.43 | $4,958.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,197.40 / $1,197.40 / $2,049.10
| Professional | | $1,197.40 | $1,197.40 | $2,049.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,138.27 / $1,138.27 / $1,138.27
| Facility | | $1,138.27 | $1,138.27 | $1,138.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.82 / $1,248.70 / $2,082.19
| Professional | | $944.82 | $1,248.70 | $2,082.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.87 / $981.87 / $1,139.38
| Facility | | $981.87 | $981.87 | $1,139.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.47 / $987.94 / $1,139.38
| Professional | | $950.47 | $987.94 | $1,139.38 |
- 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
- $914.48 / $1,215.14 / $2,001.78
| Professional | | $914.48 | $1,215.14 | $2,001.78 |