- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.29 / $3,830.00 / $8,240.00
| Facility | | $1,007.29 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.24 / $980.19 / $1,421.91
| Professional | | $872.24 | $980.19 | $1,421.91 |
- 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
- $972.40 / $1,044.06 / $1,770.04
| Professional | | $972.40 | $1,044.06 | $1,770.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.09 / $1,098.09 / $1,098.09
| Facility | | $1,098.09 | $1,098.09 | $1,098.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.29 / $1,171.32 / $1,957.32
| Professional | | $914.29 | $1,171.32 | $1,957.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.60 / $1,557.29 / $1,983.96
| Professional | | $1,148.60 | $1,557.29 | $1,983.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,597.00 / $8,404.00
| Facility | | $1,020.00 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.24 / $1,081.84 / $4,831.00
| Professional | | $872.24 | $1,081.84 | $4,831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.40 / $1,189.40 / $1,976.90
| Professional | | $1,189.40 | $1,189.40 | $1,976.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.09 / $1,098.09 / $1,098.09
| Facility | | $1,098.09 | $1,098.09 | $1,098.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.29 / $1,204.57 / $2,006.15
| Professional | | $914.29 | $1,204.57 | $2,006.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.70 / $947.70 / $1,240.74
| Facility | | $947.70 | $947.70 | $1,240.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.54 / $953.42 / $1,240.74
| Professional | | $917.54 | $953.42 | $1,240.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.00 / $3,742.00 / $7,000.00
| Facility | | $1,843.00 | $3,742.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.93 / $1,173.50 / $1,804.08
| Professional | | $920.93 | $1,173.50 | $1,804.08 |