- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.91 / $3,830.00 / $8,240.00
| Facility | | $1,060.91 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.23 / $1,036.26 / $1,544.71
| Professional | | $924.23 | $1,036.26 | $1,544.71 |
- 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
- $1,020.41 / $1,058.92 / $1,058.92
| Professional | | $1,020.41 | $1,058.92 | $1,058.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.19 / $1,164.19 / $1,164.19
| Facility | | $1,164.19 | $1,164.19 | $1,164.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.34 / $1,282.47 / $2,094.25
| Professional | | $986.34 | $1,282.47 | $2,094.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.80 / $1,645.39 / $2,067.19
| Professional | | $1,196.80 | $1,645.39 | $2,067.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.91 / $4,597.00 / $8,404.00
| Facility | | $1,060.91 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.23 / $1,153.36 / $4,966.08
| Professional | | $924.23 | $1,153.36 | $4,966.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.90 / $1,456.90 / $2,493.50
| Professional | | $1,456.90 | $1,456.90 | $2,493.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.19 / $1,164.19 / $1,164.19
| Facility | | $1,164.19 | $1,164.19 | $1,164.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.34 / $1,301.36 / $2,136.11
| Professional | | $986.34 | $1,301.36 | $2,136.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.86 / $996.86 / $1,112.11
| Facility | | $996.86 | $996.86 | $1,112.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.07 / $1,013.20 / $1,112.11
| Professional | | $955.07 | $1,013.20 | $1,112.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $4,563.00 / $9,631.00
| Facility | | $2,468.00 | $4,563.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.68 / $1,266.19 / $1,987.36
| Professional | | $968.68 | $1,266.19 | $1,987.36 |