- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,048.00 / $8,451.00
| Facility | | $1,020.00 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.46 / $944.13 / $1,381.33
| Professional | | $846.46 | $944.13 | $1,381.33 |
- 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
- $944.65 / $1,012.61 / $1,716.02
| Professional | | $944.65 | $1,012.61 | $1,716.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.85 / $1,066.85 / $1,066.85
| Facility | | $1,066.85 | $1,066.85 | $1,066.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.77 / $1,131.45 / $1,883.93
| Professional | | $889.77 | $1,131.45 | $1,883.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.08 / $1,513.76 / $1,927.80
| Professional | | $1,116.08 | $1,513.76 | $1,927.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $4,993.00 / $10,247.00
| Facility | | $1,151.00 | $4,993.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.46 / $1,013.23 / $4,645.85
| Professional | | $846.46 | $1,013.23 | $4,645.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.30 / $1,165.30 / $1,918.50
| Professional | | $1,165.30 | $1,165.30 | $1,918.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.85 / $1,066.85 / $1,066.85
| Facility | | $1,066.85 | $1,066.85 | $1,066.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.77 / $1,170.42 / $1,899.40
| Professional | | $889.77 | $1,170.42 | $1,899.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.26 / $920.26 / $1,073.29
| Facility | | $920.26 | $920.26 | $1,073.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.99 / $925.80 / $1,073.29
| Professional | | $890.99 | $925.80 | $1,073.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $6,515.00 / $12,076.00
| Facility | | $3,340.00 | $6,515.00 | $12,076.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.29 / $1,137.34 / $1,904.88
| Professional | | $855.29 | $1,137.34 | $1,904.88 |