- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.54 / $3,830.00 / $8,240.00
| Facility | | $1,319.54 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.23 / $1,303.92 / $1,991.27
| Professional | | $1,145.23 | $1,303.92 | $1,991.27 |
- 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
- $1,273.70 / $1,360.75 / $2,335.31
| Professional | | $1,273.70 | $1,360.75 | $2,335.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.74 / $1,440.74 / $1,440.74
| Facility | | $1,440.74 | $1,440.74 | $1,440.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.59 / $1,559.50 / $2,564.07
| Professional | | $1,201.59 | $1,559.50 | $2,564.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.58 / $2,036.38 / $2,591.90
| Professional | | $1,500.58 | $2,036.38 | $2,591.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.94 / $1,279.94 / $1,279.94
| Professional | | $1,279.94 | $1,279.94 | $1,279.94 |
- 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
- $1,182.98 / $1,415.43 / $3,919.03
| Professional | | $1,182.98 | $1,415.43 | $3,919.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.20 / $1,523.20 / $2,583.10
| Professional | | $1,523.20 | $1,523.20 | $2,583.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.74 / $1,440.74 / $1,440.74
| Facility | | $1,440.74 | $1,440.74 | $1,440.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.59 / $1,579.97 / $2,643.47
| Professional | | $1,201.59 | $1,579.97 | $2,643.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.55 / $1,242.55 / $1,324.01
| Facility | | $1,242.55 | $1,242.55 | $1,324.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.32 / $1,251.81 / $1,324.01
| Professional | | $1,201.32 | $1,251.81 | $1,324.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.20 / $1,591.71 / $2,730.23
| Professional | | $1,195.20 | $1,591.71 | $2,730.23 |