- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.53 / $4,048.00 / $8,451.00
| Facility | | $1,126.53 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.56 / $1,101.61 / $1,596.69
| Professional | | $986.56 | $1,101.61 | $1,596.69 |
- 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
- $1,091.93 / $1,133.13 / $1,133.13
| Professional | | $1,091.93 | $1,133.13 | $1,133.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.70 / $1,243.70 / $1,243.70
| Facility | | $1,243.70 | $1,243.70 | $1,243.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.93 / $1,372.99 / $2,226.94
| Professional | | $1,039.93 | $1,372.99 | $2,226.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.01 / $1,707.89 / $2,202.29
| Professional | | $1,275.01 | $1,707.89 | $2,202.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.53 / $4,993.00 / $10,247.00
| Facility | | $1,126.53 | $4,993.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $997.86 / $1,215.60 / $5,371.61
| Professional | | $997.86 | $1,215.60 | $5,371.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,273.70 / $1,273.70 / $2,437.10
| Professional | | $1,273.70 | $1,273.70 | $2,437.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.70 / $1,243.70 / $1,243.70
| Facility | | $1,243.70 | $1,243.70 | $1,243.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.29 / $1,390.66 / $2,331.75
| Professional | | $1,042.29 | $1,390.66 | $2,331.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.54 / $1,074.54 / $1,235.68
| Facility | | $1,074.54 | $1,074.54 | $1,235.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.68 / $1,078.61 / $1,235.68
| Professional | | $1,042.68 | $1,078.61 | $1,235.68 |
- 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
- $1,023.43 / $1,310.96 / $2,156.92
| Professional | | $1,023.43 | $1,310.96 | $2,156.92 |