- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.04 / $3,830.00 / $8,240.00
| Facility | | $1,030.04 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.21 / $964.39 / $1,461.71
| Professional | | $888.21 | $964.39 | $1,461.71 |
- 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
- $988.39 / $1,025.68 / $1,025.68
| Professional | | $988.39 | $1,025.68 | $1,025.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.04 / $1,120.04 / $1,120.04
| Facility | | $1,120.04 | $1,120.04 | $1,120.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.93 / $1,170.04 / $1,980.46
| Professional | | $913.93 | $1,170.04 | $1,980.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.92 / $1,588.01 / $2,025.95
| Professional | | $1,172.92 | $1,588.01 | $2,025.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,077.64 / $11,077.64 / $11,077.64
| Facility | | $11,077.64 | $11,077.64 | $11,077.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,252.94 / $2,252.94 / $2,252.94
| Professional | | $2,252.94 | $2,252.94 | $2,252.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.04 / $4,761.00 / $8,404.00
| Facility | | $1,030.04 | $4,761.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.59 / $1,090.73 / $4,916.84
| Professional | | $899.59 | $1,090.73 | $4,916.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.40 / $1,171.40 / $2,029.80
| Professional | | $1,171.40 | $1,171.40 | $2,029.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.04 / $1,120.04 / $1,120.04
| Facility | | $1,120.04 | $1,120.04 | $1,120.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.93 / $1,200.15 / $2,001.52
| Professional | | $913.93 | $1,200.15 | $2,001.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.05 / $964.05 / $1,144.84
| Facility | | $964.05 | $964.05 | $1,144.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.26 / $967.17 / $1,144.84
| Professional | | $936.26 | $967.17 | $1,144.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.04 / $1,191.25 / $1,982.82
| Professional | | $876.04 | $1,191.25 | $1,982.82 |