- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.24 / $2,747.00 / $8,247.00
| Facility | | $1,095.24 | $2,747.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.94 / $1,098.47 / $1,474.21
| Professional | | $924.94 | $1,098.47 | $1,474.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.54 / $1,251.03 / $2,043.03
| Professional | | $1,205.54 | $1,251.03 | $2,043.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.34 / $1,366.34 / $1,366.34
| Facility | | $1,366.34 | $1,366.34 | $1,366.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.73 / $1,312.31 / $2,308.69
| Professional | | $901.73 | $1,312.31 | $2,308.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,447.82 / $2,037.89 / $2,500.78
| Professional | | $1,447.82 | $2,037.89 | $2,500.78 |
- 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
- $1,024.28 / $1,230.32 / $5,958.00
| Professional | | $1,024.28 | $1,230.32 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.80 / $1,160.80 / $2,419.00
| Professional | | $1,160.80 | $1,160.80 | $2,419.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.34 / $1,366.34 / $1,366.34
| Facility | | $1,366.34 | $1,366.34 | $1,366.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.91 / $1,335.89 / $2,308.69
| Professional | | $958.91 | $1,335.89 | $2,308.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.84 / $1,172.84 / $1,219.68
| Facility | | $1,172.84 | $1,172.84 | $1,219.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.93 / $1,196.31 / $1,248.03
| Professional | | $1,117.93 | $1,196.31 | $1,248.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.00 / $2,956.46 / $6,368.00
| Facility | | $1,214.00 | $2,956.46 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.94 / $1,375.61 / $2,121.42
| Professional | | $1,012.94 | $1,375.61 | $2,121.42 |