- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.18 / $4,050.00 / $9,534.00
| Facility | | $1,049.18 | $4,050.00 | $9,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.83 / $1,020.54 / $1,482.08
| Professional | | $908.83 | $1,020.54 | $1,482.08 |
- 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
- $1,013.55 / $1,071.33 / $1,846.38
| Professional | | $1,013.55 | $1,071.33 | $1,846.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.23 / $1,144.23 / $1,144.23
| Facility | | $1,144.23 | $1,144.23 | $1,144.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.73 / $1,243.03 / $2,038.72
| Professional | | $955.73 | $1,243.03 | $2,038.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.90 / $1,623.61 / $2,067.37
| Professional | | $1,196.90 | $1,623.61 | $2,067.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $5,350.00 / $10,510.00
| Facility | | $1,151.00 | $5,350.00 | $10,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.83 / $1,104.18 / $4,983.37
| Professional | | $908.83 | $1,104.18 | $4,983.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.00 / $1,201.00 / $2,057.90
| Professional | | $1,201.00 | $1,201.00 | $2,057.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.23 / $1,144.23 / $1,144.23
| Facility | | $1,144.23 | $1,144.23 | $1,144.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.73 / $1,255.28 / $2,092.26
| Professional | | $955.73 | $1,255.28 | $2,092.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.80 / $986.80 / $1,208.35
| Facility | | $986.80 | $986.80 | $1,208.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.20 / $992.95 / $1,208.35
| Professional | | $955.20 | $992.95 | $1,208.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $6,515.00 / $10,875.00
| Facility | | $3,340.00 | $6,515.00 | $10,875.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.19 / $1,223.02 / $2,039.89
| Professional | | $945.19 | $1,223.02 | $2,039.89 |