- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.00 / $3,830.00 / $8,240.00
| Facility | | $1,101.00 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.78 / $1,078.34 / $1,670.39
| Professional | | $937.78 | $1,078.34 | $1,670.39 |
- 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
- $1,073.09 / $1,113.59 / $1,113.59
| Professional | | $1,073.09 | $1,113.59 | $1,113.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.10 / $1,224.10 / $1,224.10
| Facility | | $1,224.10 | $1,224.10 | $1,224.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.36 / $1,366.69 / $2,185.42
| Professional | | $1,012.36 | $1,366.69 | $2,185.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.02 / $1,684.89 / $2,172.94
| Professional | | $1,258.02 | $1,684.89 | $2,172.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.00 / $4,597.00 / $8,404.00
| Facility | | $1,101.00 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.89 / $1,246.84 / $5,735.22
| Professional | | $951.89 | $1,246.84 | $5,735.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,209.20 / $1,209.20 / $2,318.10
| Professional | | $1,209.20 | $1,209.20 | $2,318.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.10 / $1,224.10 / $1,224.10
| Facility | | $1,224.10 | $1,224.10 | $1,224.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.53 / $1,392.36 / $2,191.08
| Professional | | $1,022.53 | $1,392.36 | $2,191.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.51 / $1,064.51 / $1,205.26
| Facility | | $1,064.51 | $1,064.51 | $1,205.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.05 / $1,066.58 / $1,205.26
| Professional | | $1,035.05 | $1,066.58 | $1,205.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,879.00 / $7,508.00
| Facility | | $2,332.00 | $3,879.00 | $7,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.10 / $1,377.88 / $2,058.94
| Professional | | $1,037.10 | $1,377.88 | $2,058.94 |