- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.02 / $4,761.00 / $8,451.00
| Facility | | $1,112.02 | $4,761.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.79 / $1,214.96 / $2,148.38
| Professional | | $1,035.79 | $1,214.96 | $2,148.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.34 / $1,724.79 / $2,296.23
| Professional | | $1,095.34 | $1,724.79 | $2,296.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.79 / $1,614.07 / $2,503.41
| Professional | | $1,187.79 | $1,614.07 | $2,503.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,464.47 / $1,946.93 / $1,946.93
| Professional | | $1,464.47 | $1,946.93 | $1,946.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,026.78 / $7,602.44 / $41,899.85
| Facility | | $7,026.78 | $7,602.44 | $41,899.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.02 / $5,342.00 / $9,617.00
| Facility | | $1,112.02 | $5,342.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.81 / $1,372.83 / $3,302.69
| Professional | | $1,097.81 | $1,372.83 | $3,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,861.70 / $3,132.90
| Professional | | $6.00 | $1,861.70 | $3,132.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.13 / $1,615.09 / $2,733.36
| Professional | | $1,191.13 | $1,615.09 | $2,733.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.36 / $1,226.36 / $1,423.97
| Facility | | $1,226.36 | $1,226.36 | $1,423.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.95 / $1,237.53 / $1,423.97
| Professional | | $1,183.95 | $1,237.53 | $1,423.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.39 / $1,534.56 / $2,704.53
| Professional | | $1,202.39 | $1,534.56 | $2,704.53 |