- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.00 / $4,250.00 / $10,398.00
| Facility | | $1,278.00 | $4,250.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.38 / $1,001.72 / $1,466.90
| Professional | | $908.38 | $1,001.72 | $1,466.90 |
- 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
- $1,003.17 / $1,041.03 / $1,847.18
| Professional | | $1,003.17 | $1,041.03 | $1,847.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.13 / $1,135.13 / $1,135.13
| Facility | | $1,135.13 | $1,135.13 | $1,135.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.91 / $1,203.16 / $1,992.89
| Professional | | $887.91 | $1,203.16 | $1,992.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.88 / $1,594.78 / $2,039.71
| Professional | | $1,180.88 | $1,594.78 | $2,039.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.00 / $5,511.00 / $11,083.00
| Facility | | $1,426.00 | $5,511.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.38 / $1,052.04 / $5,331.84
| Professional | | $908.38 | $1,052.04 | $5,331.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.40 / $1,055.40 / $2,055.69
| Professional | | $1,055.40 | $1,055.40 | $2,055.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.13 / $1,135.13 / $1,135.13
| Facility | | $1,135.13 | $1,135.13 | $1,135.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.69 / $1,230.30 / $2,031.98
| Professional | | $897.69 | $1,230.30 | $2,031.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.11 / $985.46 / $985.46
| Facility | | $917.11 | $985.46 | $985.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.11 / $985.46 / $1,042.26
| Professional | | $917.11 | $985.46 | $1,042.26 |
- 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
- $899.73 / $1,181.50 / $1,994.87
| Professional | | $899.73 | $1,181.50 | $1,994.87 |