- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.38 / $3,830.00 / $8,240.00
| Facility | | $1,077.38 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.08 / $987.88 / $1,359.37
| Professional | | $928.08 | $987.88 | $1,359.37 |
- 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
- $993.20 / $1,030.68 / $1,030.68
| Professional | | $993.20 | $1,030.68 | $1,030.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.67 / $1,145.67 / $1,145.67
| Facility | | $1,145.67 | $1,145.67 | $1,145.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.70 / $1,184.19 / $1,953.28
| Professional | | $880.70 | $1,184.19 | $1,953.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.49 / $1,578.78 / $2,037.29
| Professional | | $1,179.49 | $1,578.78 | $2,037.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,597.00 / $8,404.00
| Facility | | $1,020.00 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.08 / $1,077.38 / $5,075.47
| Professional | | $928.08 | $1,077.38 | $5,075.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.00 / $964.00 / $2,149.60
| Professional | | $964.00 | $964.00 | $2,149.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.67 / $1,145.67 / $1,145.67
| Facility | | $1,145.67 | $1,145.67 | $1,145.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.67 / $1,197.25 / $1,990.97
| Professional | | $888.67 | $1,197.25 | $1,990.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.29 / $1,000.52 / $1,000.52
| Facility | | $940.29 | $1,000.52 | $1,000.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.29 / $1,000.52 / $1,067.85
| Professional | | $940.29 | $1,000.52 | $1,067.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.00 / $2,824.00 / $5,678.00
| Facility | | $1,747.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.03 / $1,144.67 / $1,794.54
| Professional | | $840.03 | $1,144.67 | $1,794.54 |