- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.73 / $3,066.00 / $7,799.00
| Facility | | $1,007.73 | $3,066.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.54 / $987.39 / $1,466.90
| Professional | | $843.54 | $987.39 | $1,466.90 |
- 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
- $1,003.17 / $1,041.03 / $1,883.49
| Professional | | $1,003.17 | $1,041.03 | $1,883.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.08 / $1,145.08 / $1,145.08
| Facility | | $1,145.08 | $1,145.08 | $1,145.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.73 / $1,180.96 / $1,997.62
| Professional | | $799.73 | $1,180.96 | $1,997.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.38 / $1,504.85 / $1,978.38
| Professional | | $1,145.38 | $1,504.85 | $1,978.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.73 / $3,839.00 / $8,017.00
| Facility | | $1,007.73 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.83 / $1,063.57 / $4,805.07
| Professional | | $901.83 | $1,063.57 | $4,805.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.20 / $1,085.20 / $2,071.00
| Professional | | $1,085.20 | $1,085.20 | $2,071.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.08 / $1,145.08 / $1,145.08
| Facility | | $1,145.08 | $1,145.08 | $1,145.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.49 / $1,209.81 / $2,084.46
| Professional | | $882.49 | $1,209.81 | $2,084.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.42 / $976.00 / $976.00
| Facility | | $905.42 | $976.00 | $976.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.42 / $976.00 / $1,014.02
| Professional | | $905.42 | $976.00 | $1,014.02 |
- 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
- $859.31 / $1,173.52 / $2,024.35
| Professional | | $859.31 | $1,173.52 | $2,024.35 |