- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.50 / $2,747.00 / $8,017.00
| Facility | | $1,041.50 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.58 / $1,004.55 / $1,631.42
| Professional | | $879.58 | $1,004.55 | $1,631.42 |
- 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
- $1,022.06 / $1,302.36 / $1,884.90
| Professional | | $1,022.06 | $1,302.36 | $1,884.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,155.38 / $1,155.38 / $1,155.38
| Facility | | $1,155.38 | $1,155.38 | $1,155.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.76 / $1,267.04 / $2,067.33
| Professional | | $858.76 | $1,267.04 | $2,067.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.59 / $1,638.69 / $2,088.27
| Professional | | $1,229.59 | $1,638.69 | $2,088.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,077.00 / $8,017.00
| Facility | | $1,013.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.58 / $1,086.86 / $2,562.09
| Professional | | $879.58 | $1,086.86 | $2,562.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.90 / $910.90 / $2,239.60
| Professional | | $910.90 | $910.90 | $2,239.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,155.38 / $1,155.38 / $1,155.38
| Facility | | $1,155.38 | $1,155.38 | $1,155.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.03 / $1,283.25 / $2,067.33
| Professional | | $916.03 | $1,283.25 | $2,067.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.60 / $998.57 / $998.57
| Facility | | $757.60 | $998.57 | $998.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.60 / $998.57 / $1,058.96
| Professional | | $757.60 | $998.57 | $1,058.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,879.00 / $7,000.00
| Facility | | $2,332.00 | $3,879.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.15 / $1,334.39 / $2,070.37
| Professional | | $927.15 | $1,334.39 | $2,070.37 |