- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.00 / $4,048.00 / $8,451.00
| Facility | | $1,461.00 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.78 / $1,511.48 / $2,295.67
| Professional | | $1,315.78 | $1,511.48 | $2,295.67 |
- 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
- $1,464.25 / $1,590.66 / $2,709.26
| Professional | | $1,464.25 | $1,590.66 | $2,709.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,656.40 / $1,656.40 / $1,656.40
| Facility | | $1,656.40 | $1,656.40 | $1,656.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.37 / $1,795.78 / $2,944.20
| Professional | | $1,381.37 | $1,795.78 | $2,944.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.94 / $2,340.31 / $2,977.72
| Professional | | $1,723.94 | $2,340.31 | $2,977.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,638.15 / $8,638.15 / $8,638.15
| Facility | | $8,638.15 | $8,638.15 | $8,638.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,638.25 / $11,638.25 / $12,337.00
| Professional | | $11,638.25 | $11,638.25 | $12,337.00 |
- 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
- $1,342.89 / $1,524.60 / $3,608.26
| Professional | | $1,342.89 | $1,524.60 | $3,608.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,785.30 / $1,785.30 / $2,994.50
| Professional | | $1,785.30 | $1,785.30 | $2,994.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,656.40 / $1,656.40 / $1,656.40
| Facility | | $1,656.40 | $1,656.40 | $1,656.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.37 / $1,826.98 / $3,054.87
| Professional | | $1,381.37 | $1,826.98 | $3,054.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.39 / $1,427.39 / $1,575.17
| Facility | | $1,427.39 | $1,427.39 | $1,575.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.60 / $1,438.73 / $1,575.17
| Professional | | $1,379.60 | $1,438.73 | $1,575.17 |
- 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
- $1,377.18 / $1,783.88 / $2,808.63
| Professional | | $1,377.18 | $1,783.88 | $2,808.63 |