- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.07 / $4,048.00 / $8,451.00
| Facility | | $1,230.07 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.58 / $1,213.02 / $2,015.42
| Professional | | $1,066.58 | $1,213.02 | $2,015.42 |
- 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
- $1,188.20 / $1,282.36 / $2,176.29
| Professional | | $1,188.20 | $1,282.36 | $2,176.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.78 / $1,342.78 / $1,342.78
| Facility | | $1,342.78 | $1,342.78 | $1,342.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.94 / $1,444.42 / $2,390.21
| Professional | | $1,120.94 | $1,444.42 | $2,390.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.40 / $1,901.06 / $2,420.60
| Professional | | $1,401.40 | $1,901.06 | $2,420.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,226.14 / $53,226.14 / $53,226.14
| Facility | | $53,226.14 | $53,226.14 | $53,226.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $4,894.00 / $10,247.00
| Facility | | $1,151.00 | $4,894.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.33 / $1,395.89 / $5,837.04
| Professional | | $1,073.33 | $1,395.89 | $5,837.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.60 / $1,454.60 / $2,413.30
| Professional | | $1,454.60 | $1,454.60 | $2,413.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.78 / $1,342.78 / $1,342.78
| Facility | | $1,342.78 | $1,342.78 | $1,342.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.94 / $1,470.15 / $2,456.73
| Professional | | $1,120.94 | $1,470.15 | $2,456.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.44 / $1,158.44 / $1,293.60
| Facility | | $1,158.44 | $1,158.44 | $1,293.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.33 / $1,166.47 / $1,293.60
| Professional | | $1,120.33 | $1,166.47 | $1,293.60 |
- 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
- $1,087.51 / $1,417.99 / $2,246.59
| Professional | | $1,087.51 | $1,417.99 | $2,246.59 |