- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.59 / $4,048.00 / $8,451.00
| Facility | | $1,144.59 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.88 / $1,114.18 / $1,618.93
| Professional | | $991.88 | $1,114.18 | $1,618.93 |
- 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
- $1,107.14 / $1,148.92 / $2,031.03
| Professional | | $1,107.14 | $1,148.92 | $2,031.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,249.94 / $1,249.94 / $1,249.94
| Facility | | $1,249.94 | $1,249.94 | $1,249.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.92 / $1,343.45 / $2,224.13
| Professional | | $1,032.92 | $1,343.45 | $2,224.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,306.71 / $1,772.13 / $2,257.05
| Professional | | $1,306.71 | $1,772.13 | $2,257.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.61 / $1,198.61 / $1,198.61
| Professional | | $1,198.61 | $1,198.61 | $1,198.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.59 / $5,342.00 / $10,247.00
| Facility | | $1,144.59 | $5,342.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.25 / $1,209.75 / $5,434.28
| Professional | | $993.25 | $1,209.75 | $5,434.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,273.70 / $1,273.70 / $2,264.30
| Professional | | $1,273.70 | $1,273.70 | $2,264.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,249.94 / $1,249.94 / $1,249.94
| Facility | | $1,249.94 | $1,249.94 | $1,249.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.73 / $1,368.10 / $2,238.48
| Professional | | $1,034.73 | $1,368.10 | $2,238.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.34 / $1,077.42 / $1,077.42
| Facility | | $1,065.34 | $1,077.42 | $1,077.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.00 / $1,077.42 / $1,140.36
| Professional | | $1,043.00 | $1,077.42 | $1,140.36 |
- 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
- $1,048.32 / $1,378.48 / $2,358.17
| Professional | | $1,048.32 | $1,378.48 | $2,358.17 |