- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.81 / $2,747.00 / $8,266.82
| Facility | | $1,044.81 | $2,747.00 | $8,266.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.40 / $1,139.43 / $1,915.87
| Professional | | $977.40 | $1,139.43 | $1,915.87 |
- 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
- $1,244.80 / $1,291.77 / $1,291.77
| Professional | | $1,244.80 | $1,291.77 | $1,291.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,409.80 / $1,409.80 / $1,409.80
| Facility | | $1,409.80 | $1,409.80 | $1,409.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.83 / $1,453.60 / $2,296.98
| Professional | | $1,026.83 | $1,453.60 | $2,296.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,494.80 / $2,104.46 / $2,581.92
| Professional | | $1,494.80 | $2,104.46 | $2,581.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,427.00
| Facility | | $1,013.00 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.13 / $1,287.50 / $2,853.65
| Professional | | $1,012.13 | $1,287.50 | $2,853.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.30 / $1,257.30 / $2,436.90
| Professional | | $1,257.30 | $1,257.30 | $2,436.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,409.80 / $1,409.80 / $1,409.80
| Facility | | $1,409.80 | $1,409.80 | $1,409.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.51 / $1,484.36 / $2,302.59
| Professional | | $1,041.51 | $1,484.36 | $2,302.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.22 / $1,120.22 / $1,305.27
| Facility | | $1,120.22 | $1,120.22 | $1,305.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.61 / $1,135.18 / $1,305.27
| Professional | | $1,076.61 | $1,135.18 | $1,305.27 |
- 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
- $1,104.09 / $1,429.52 / $2,294.62
| Professional | | $1,104.09 | $1,429.52 | $2,294.62 |