- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.45 / $4,048.00 / $8,451.00
| Facility | | $1,261.45 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.81 / $1,220.57 / $1,762.82
| Professional | | $1,106.81 | $1,220.57 | $1,762.82 |
- 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
- $1,223.83 / $1,270.02 / $1,270.02
| Professional | | $1,223.83 | $1,270.02 | $1,270.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.30 / $1,381.30 / $1,381.30
| Facility | | $1,381.30 | $1,381.30 | $1,381.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.56 / $1,501.09 / $2,463.51
| Professional | | $1,154.56 | $1,501.09 | $2,463.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.62 / $1,893.69 / $2,465.90
| Professional | | $1,427.62 | $1,893.69 | $2,465.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,170.90 / $18,170.90 / $18,170.90
| Facility | | $18,170.90 | $18,170.90 | $18,170.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $4,993.00 / $10,247.00
| Facility | | $1,151.00 | $4,993.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.08 / $1,343.37 / $3,746.50
| Professional | | $1,133.08 | $1,343.37 | $3,746.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.20 / $1,332.20 / $2,551.60
| Professional | | $1,332.20 | $1,332.20 | $2,551.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.30 / $1,381.30 / $1,381.30
| Facility | | $1,381.30 | $1,381.30 | $1,381.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.38 / $1,558.65 / $2,610.00
| Professional | | $1,160.38 | $1,558.65 | $2,610.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.76 / $1,202.76 / $1,274.58
| Facility | | $1,202.76 | $1,202.76 | $1,274.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.08 / $1,202.76 / $1,274.58
| Professional | | $1,173.08 | $1,202.76 | $1,274.58 |
- 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
- $1,115.10 / $1,504.37 / $2,388.96
| Professional | | $1,115.10 | $1,504.37 | $2,388.96 |