- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.72 / $3,494.00 / $7,799.00
| Facility | | $1,058.72 | $3,494.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.48 / $1,013.95 / $1,611.38
| Professional | | $929.48 | $1,013.95 | $1,611.38 |
- 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
- $1,044.06 / $1,489.48 / $1,973.52
| Professional | | $1,044.06 | $1,489.48 | $1,973.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.78 / $1,179.78 / $1,179.78
| Facility | | $1,179.78 | $1,179.78 | $1,179.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.02 / $1,248.20 / $2,057.27
| Professional | | $964.02 | $1,248.20 | $2,057.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.58 / $1,637.26 / $2,103.09
| Professional | | $1,217.58 | $1,637.26 | $2,103.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,964.00 / $8,017.00
| Facility | | $1,020.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.48 / $1,068.00 / $2,843.00
| Professional | | $929.48 | $1,068.00 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.00 / $957.00 / $2,077.10
| Professional | | $957.00 | $957.00 | $2,077.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.78 / $1,179.78 / $1,179.78
| Facility | | $1,179.78 | $1,179.78 | $1,179.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.16 / $1,271.73 / $2,101.88
| Professional | | $974.16 | $1,271.73 | $2,101.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.77 / $1,008.13 / $1,008.13
| Facility | | $941.77 | $1,008.13 | $1,008.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.77 / $1,008.13 / $1,058.85
| Professional | | $941.77 | $1,008.13 | $1,058.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $2,715.00 / $4,815.00
| Facility | | $1,175.00 | $2,715.00 | $4,815.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.80 / $1,217.40 / $2,090.08
| Professional | | $926.80 | $1,217.40 | $2,090.08 |