- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.88 / $2,747.00 / $8,113.00
| Facility | | $1,143.88 | $2,747.00 | $8,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.16 / $1,075.86 / $1,407.45
| Professional | | $910.16 | $1,075.86 | $1,407.45 |
- 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
- $1,103.18 / $1,144.81 / $1,864.37
| Professional | | $1,103.18 | $1,144.81 | $1,864.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.64 / $1,247.64 / $1,247.64
| Facility | | $1,247.64 | $1,247.64 | $1,247.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.48 / $1,294.46 / $2,128.12
| Professional | | $924.48 | $1,294.46 | $2,128.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.67 / $1,769.19 / $2,255.23
| Professional | | $1,305.67 | $1,769.19 | $2,255.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,427.00
| Facility | | $1,013.00 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.21 / $1,145.28 / $5,446.96
| Professional | | $933.21 | $1,145.28 | $5,446.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.30 / $1,215.30 / $2,249.30
| Professional | | $1,215.30 | $1,215.30 | $2,249.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.64 / $1,247.64 / $1,247.64
| Facility | | $1,247.64 | $1,247.64 | $1,247.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.86 / $1,324.66 / $2,167.87
| Professional | | $948.86 | $1,324.66 | $2,167.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.42 / $1,075.42 / $1,107.48
| Facility | | $1,075.42 | $1,075.42 | $1,107.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.35 / $1,080.69 / $1,140.92
| Professional | | $1,042.35 | $1,080.69 | $1,140.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $4,563.00 / $9,631.00
| Facility | | $2,468.00 | $4,563.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.21 / $1,290.52 / $2,206.85
| Professional | | $980.21 | $1,290.52 | $2,206.85 |