- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.98 / $4,051.00 / $9,907.00
| Facility | | $1,133.98 | $4,051.00 | $9,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.93 / $1,120.25 / $1,723.95
| Professional | | $982.93 | $1,120.25 | $1,723.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $25,716.00 / $39,341.64
| Facility | | $8,639.91 | $25,716.00 | $39,341.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.61 / $1,179.83 / $2,002.13
| Professional | | $1,094.61 | $1,179.83 | $2,002.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.73 / $1,236.73 / $1,236.73
| Facility | | $1,236.73 | $1,236.73 | $1,236.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.15 / $1,342.45 / $2,203.50
| Professional | | $1,039.15 | $1,342.45 | $2,203.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.47 / $1,751.93 / $2,230.71
| Professional | | $1,291.47 | $1,751.93 | $2,230.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,037.40 / $35,037.40 / $35,037.40
| Facility | | $35,037.40 | $35,037.40 | $35,037.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $5,342.00 / $10,247.00
| Facility | | $1,151.00 | $5,342.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.34 / $1,221.70 / $2,773.26
| Professional | | $1,015.34 | $1,221.70 | $2,773.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.30 / $1,388.30 / $2,226.90
| Professional | | $1,388.30 | $1,388.30 | $2,226.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.73 / $1,236.73 / $1,236.73
| Facility | | $1,236.73 | $1,236.73 | $1,236.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.15 / $1,354.72 / $2,267.59
| Professional | | $1,039.15 | $1,354.72 | $2,267.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.19 / $1,067.19 / $1,240.34
| Facility | | $1,067.19 | $1,067.19 | $1,240.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.53 / $1,074.35 / $1,240.34
| Professional | | $1,032.53 | $1,074.35 | $1,240.34 |
- 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
- $1,033.77 / $1,338.57 / $2,177.88
| Professional | | $1,033.77 | $1,338.57 | $2,177.88 |