- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.60 / $3,339.00 / $7,799.00
| Facility | | $1,096.60 | $3,339.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.90 / $1,071.56 / $1,582.52
| Professional | | $949.90 | $1,071.56 | $1,582.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.68 / $1,512.53 / $2,179.39
| Professional | | $1,059.68 | $1,512.53 | $2,179.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.05 / $1,197.05 / $1,197.05
| Facility | | $1,197.05 | $1,197.05 | $1,197.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.28 / $1,325.99 / $2,130.88
| Professional | | $1,014.28 | $1,325.99 | $2,130.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.80 / $1,695.26 / $2,162.19
| Professional | | $1,251.80 | $1,695.26 | $2,162.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.58 / $1,171.58 / $1,171.58
| Professional | | $1,171.58 | $1,171.58 | $1,171.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,017.00
| Facility | | $1,020.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.21 / $1,182.76 / $3,494.00
| Professional | | $981.21 | $1,182.76 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.80 / $1,186.70 / $2,179.69
| Professional | | $1,150.80 | $1,186.70 | $2,179.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.05 / $1,197.05 / $1,197.05
| Facility | | $1,197.05 | $1,197.05 | $1,197.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.51 / $1,328.81 / $2,190.07
| Professional | | $1,020.51 | $1,328.81 | $2,190.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.28 / $1,032.28 / $1,054.03
| Facility | | $1,032.28 | $1,032.28 | $1,054.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.21 / $1,037.72 / $1,093.66
| Professional | | $1,000.21 | $1,037.72 | $1,093.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.00 / $2,824.00 / $5,678.00
| Facility | | $1,747.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.48 / $1,322.35 / $2,070.04
| Professional | | $1,010.48 | $1,322.35 | $2,070.04 |