- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.41 / $2,747.00 / $8,247.00
| Facility | | $1,010.41 | $2,747.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.91 / $988.56 / $1,533.18
| Professional | | $860.91 | $988.56 | $1,533.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,296.00
| Facility | | $13,531.00 | $27,840.00 | $46,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.95 / $1,022.12 / $1,022.12
| Professional | | $984.95 | $1,022.12 | $1,022.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.78 / $1,123.78 / $1,123.78
| Facility | | $1,123.78 | $1,123.78 | $1,123.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.20 / $1,254.42 / $2,001.42
| Professional | | $929.20 | $1,254.42 | $2,001.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.09 / $1,545.78 / $1,993.44
| Professional | | $1,154.09 | $1,545.78 | $1,993.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.41 / $4,761.00 / $8,427.00
| Facility | | $1,010.41 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.94 / $1,129.33 / $5,251.41
| Professional | | $861.94 | $1,129.33 | $5,251.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.09 / $1,123.09 / $2,120.40
| Professional | | $1,123.09 | $1,123.09 | $2,120.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.78 / $1,123.78 / $1,123.78
| Facility | | $1,123.78 | $1,123.78 | $1,123.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.20 / $1,268.51 / $2,005.61
| Professional | | $929.20 | $1,268.51 | $2,005.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.30 / $976.30 / $1,092.08
| Facility | | $976.30 | $976.30 | $1,092.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.19 / $978.31 / $1,092.08
| Professional | | $949.19 | $978.31 | $1,092.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $2,391.00 / $6,322.00
| Facility | | $448.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.61 / $1,241.20 / $1,940.53
| Professional | | $939.61 | $1,241.20 | $1,940.53 |