- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.00 / $2,675.00 / $8,017.00
| Facility | | $1,058.00 | $2,675.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.38 / $1,117.32 / $1,744.56
| Professional | | $963.38 | $1,117.32 | $1,744.56 |
- 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
- $1,120.75 / $1,163.04 / $2,067.51
| Professional | | $1,120.75 | $1,163.04 | $2,067.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.11 / $1,268.11 / $1,268.11
| Facility | | $1,268.11 | $1,268.11 | $1,268.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,049.29 / $1,406.78 / $2,246.19
| Professional | | $1,049.29 | $1,406.78 | $2,246.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.57 / $1,791.15 / $2,279.26
| Professional | | $1,319.57 | $1,791.15 | $2,279.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $2,679.00 / $8,017.00
| Facility | | $1,013.00 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.28 / $1,273.75 / $2,843.00
| Professional | | $974.28 | $1,273.75 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.80 / $1,269.80 / $2,285.40
| Professional | | $1,269.80 | $1,269.80 | $2,285.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.11 / $1,268.11 / $1,268.11
| Facility | | $1,268.11 | $1,268.11 | $1,268.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.31 / $1,427.37 / $2,254.92
| Professional | | $1,057.31 | $1,427.37 | $2,254.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.72 / $1,093.72 / $1,296.18
| Facility | | $1,093.72 | $1,093.72 | $1,296.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.91 / $1,102.41 / $1,296.18
| Professional | | $1,056.91 | $1,102.41 | $1,296.18 |
- 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
- $1,127.41 / $1,466.86 / $2,245.04
| Professional | | $1,127.41 | $1,466.86 | $2,245.04 |