- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.43 / $4,048.00 / $8,451.00
| Facility | | $1,085.43 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.75 / $1,050.97 / $1,506.85
| Professional | | $940.75 | $1,050.97 | $1,506.85 |
- 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
- $1,030.49 / $1,069.38 / $1,593.17
| Professional | | $1,030.49 | $1,069.38 | $1,593.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.55 / $1,166.55 / $1,166.55
| Facility | | $1,166.55 | $1,166.55 | $1,166.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.50 / $1,312.41 / $2,109.16
| Professional | | $995.50 | $1,312.41 | $2,109.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.58 / $1,629.21 / $2,101.38
| Professional | | $1,216.58 | $1,629.21 | $2,101.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.43 / $4,993.00 / $10,247.00
| Facility | | $1,085.43 | $4,993.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.78 / $1,136.30 / $5,217.95
| Professional | | $958.78 | $1,136.30 | $5,217.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.70 / $1,042.70 / $2,341.50
| Professional | | $1,042.70 | $1,042.70 | $2,341.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.55 / $1,166.55 / $1,166.55
| Facility | | $1,166.55 | $1,166.55 | $1,166.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.50 / $1,316.01 / $2,208.21
| Professional | | $995.50 | $1,316.01 | $2,208.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.61 / $1,017.61 / $1,120.69
| Facility | | $1,017.61 | $1,017.61 | $1,120.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.26 / $1,017.61 / $1,120.69
| Professional | | $992.26 | $1,017.61 | $1,120.69 |
- 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
- $891.75 / $1,230.01 / $2,032.18
| Professional | | $891.75 | $1,230.01 | $2,032.18 |