- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.81 / $3,066.00 / $7,799.00
| Facility | | $1,004.81 | $3,066.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.18 / $976.91 / $1,416.82
| Professional | | $870.18 | $976.91 | $1,416.82 |
- 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
- $968.92 / $1,040.86 / $1,763.99
| Professional | | $968.92 | $1,040.86 | $1,763.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.01 / $1,094.01 / $1,094.01
| Facility | | $1,094.01 | $1,094.01 | $1,094.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.57 / $1,234.01 / $2,004.58
| Professional | | $933.57 | $1,234.01 | $2,004.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.25 / $1,551.45 / $1,976.44
| Professional | | $1,144.25 | $1,551.45 | $1,976.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.81 / $3,839.00 / $8,017.00
| Facility | | $1,004.81 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.18 / $1,104.99 / $4,773.80
| Professional | | $870.18 | $1,104.99 | $4,773.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,623.20 / $1,623.20 / $1,971.30
| Professional | | $1,623.20 | $1,623.20 | $1,971.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.01 / $1,094.01 / $1,094.01
| Facility | | $1,094.01 | $1,094.01 | $1,094.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.96 / $1,245.13 / $2,059.91
| Professional | | $944.96 | $1,245.13 | $2,059.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.56 / $944.56 / $1,390.87
| Facility | | $944.56 | $944.56 | $1,390.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.41 / $950.36 / $1,390.87
| Professional | | $914.41 | $950.36 | $1,390.87 |
- 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
- $967.27 / $1,217.31 / $1,920.30
| Professional | | $967.27 | $1,217.31 | $1,920.30 |