- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.10 / $2,747.00 / $8,247.00
| Facility | | $1,003.10 | $2,747.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.35 / $962.74 / $1,417.63
| Professional | | $869.35 | $962.74 | $1,417.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,296.00
| Facility | | $13,531.00 | $27,840.00 | $46,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.48 / $1,045.50 / $1,774.96
| Professional | | $969.48 | $1,045.50 | $1,774.96 |
- 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
- $866.74 / $1,159.13 / $1,915.55
| Professional | | $866.74 | $1,159.13 | $1,915.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.13 / $1,552.02 / $1,976.23
| Professional | | $1,144.13 | $1,552.02 | $1,976.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.10 / $4,761.00 / $8,427.00
| Facility | | $1,003.10 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.35 / $1,005.23 / $4,762.02
| Professional | | $869.35 | $1,005.23 | $4,762.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.09 / $1,222.09 / $1,987.20
| Professional | | $1,222.09 | $1,222.09 | $1,987.20 |
- 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
- $879.70 / $1,186.48 / $1,949.18
| Professional | | $879.70 | $1,186.48 | $1,949.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.38 / $944.38 / $1,050.02
| Facility | | $944.38 | $944.38 | $1,050.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.09 / $950.65 / $1,050.02
| Professional | | $914.09 | $950.65 | $1,050.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $6,368.00 / $11,238.00
| Facility | | $3,340.00 | $6,368.00 | $11,238.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.48 / $1,171.03 / $1,901.85
| Professional | | $841.48 | $1,171.03 | $1,901.85 |