- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $2,747.00 / $8,247.00
| Facility | | $1,020.00 | $2,747.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.25 / $1,068.11 / $1,626.73
| Professional | | $926.25 | $1,068.11 | $1,626.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $26,582.19
| Facility | | $8,639.91 | $11,851.00 | $26,582.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.06 / $1,124.97 / $1,124.97
| Professional | | $1,084.06 | $1,124.97 | $1,124.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.95 / $1,224.95 / $1,224.95
| Facility | | $1,224.95 | $1,224.95 | $1,224.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.30 / $1,281.95 / $2,195.63
| Professional | | $913.30 | $1,281.95 | $2,195.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.83 / $1,727.83 / $2,210.61
| Professional | | $1,279.83 | $1,727.83 | $2,210.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,495.40 / $12,495.40 / $46,282.92
| Facility | | $12,495.40 | $12,495.40 | $46,282.92 |
- 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
- $981.92 / $1,133.28 / $2,334.56
| Professional | | $981.92 | $1,133.28 | $2,334.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.59 / $1,127.59 / $2,233.19
| Professional | | $1,127.59 | $1,127.59 | $2,233.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.95 / $1,224.95 / $1,224.95
| Facility | | $1,224.95 | $1,224.95 | $1,224.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.98 / $1,294.83 / $2,202.14
| Professional | | $952.98 | $1,294.83 | $2,202.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.23 / $1,064.23 / $1,098.14
| Facility | | $1,064.23 | $1,064.23 | $1,098.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.95 / $1,068.02 / $1,128.04
| Professional | | $1,032.95 | $1,068.02 | $1,128.04 |
- 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
- $943.95 / $1,289.33 / $2,213.57
| Professional | | $943.95 | $1,289.33 | $2,213.57 |