- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.18 / $3,830.00 / $8,240.00
| Facility | | $1,128.18 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.59 / $1,063.01 / $1,138.75
| Professional | | $975.59 | $1,063.01 | $1,138.75 |
- 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
- $1,401.63 / $1,648.98 / $2,703.43
| Professional | | $1,401.63 | $1,648.98 | $2,703.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.46 / $1,239.46 / $1,239.46
| Facility | | $1,239.46 | $1,239.46 | $1,239.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.35 / $1,300.36 / $2,192.21
| Professional | | $979.35 | $1,300.36 | $2,192.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.91 / $1,082.88 / $2,358.87
| Professional | | $828.91 | $1,082.88 | $2,358.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,597.00 / $8,404.00
| Facility | | $1,020.00 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.59 / $1,120.66 / $2,337.00
| Professional | | $975.59 | $1,120.66 | $2,337.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,735.90 / $1,735.90 / $1,883.00
| Professional | | $1,735.90 | $1,735.90 | $1,883.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.46 / $1,239.46 / $1,239.46
| Facility | | $1,239.46 | $1,239.46 | $1,239.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.65 / $1,335.03 / $2,197.26
| Professional | | $983.65 | $1,335.03 | $2,197.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,553.73 / $1,553.73 / $1,646.86
| Facility | | $1,553.73 | $1,553.73 | $1,646.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,553.73 / $1,646.86 / $1,747.31
| Professional | | $1,553.73 | $1,646.86 | $1,747.31 |
- 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
- $1,025.61 / $1,770.13 / $2,807.29
| Professional | | $1,025.61 | $1,770.13 | $2,807.29 |