- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.88 / $3,066.00 / $7,799.00
| Facility | | $1,054.88 | $3,066.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.78 / $1,026.30 / $1,489.32
| Professional | | $912.78 | $1,026.30 | $1,489.32 |
- 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
- $1,018.50 / $1,087.98 / $1,842.14
| Professional | | $1,018.50 | $1,087.98 | $1,842.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.92 / $1,150.92 / $1,150.92
| Facility | | $1,150.92 | $1,150.92 | $1,150.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.47 / $1,276.90 / $2,049.79
| Professional | | $980.47 | $1,276.90 | $2,049.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.24 / $1,632.72 / $2,080.04
| Professional | | $1,204.24 | $1,632.72 | $2,080.04 |
- 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
- $912.78 / $1,119.00 / $5,016.88
| Professional | | $912.78 | $1,119.00 | $5,016.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.50 / $1,410.50 / $2,071.69
| Professional | | $1,410.50 | $1,410.50 | $2,071.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.92 / $1,150.92 / $1,150.92
| Facility | | $1,150.92 | $1,150.92 | $1,150.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.47 / $1,297.15 / $2,089.73
| Professional | | $980.47 | $1,297.15 | $2,089.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $992.15 / $992.15 / $1,164.84
| Facility | | $992.15 | $992.15 | $1,164.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.03 / $997.64 / $1,164.84
| Professional | | $961.03 | $997.64 | $1,164.84 |
- 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
- $1,007.65 / $1,271.96 / $1,971.56
| Professional | | $1,007.65 | $1,271.96 | $1,971.56 |