- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $2,747.00 / $8,247.00
| Facility | | $1,020.00 | $2,747.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.58 / $1,003.05 / $1,499.22
| Professional | | $864.58 | $1,003.05 | $1,499.22 |
- 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
- $1,102.45 / $1,144.06 / $1,979.17
| Professional | | $1,102.45 | $1,144.06 | $1,979.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,249.74 / $1,249.74 / $1,249.74
| Facility | | $1,249.74 | $1,249.74 | $1,249.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.60 / $1,206.72 / $2,123.09
| Professional | | $807.60 | $1,206.72 | $2,123.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.58 / $1,864.17 / $2,286.17
| Professional | | $1,323.58 | $1,864.17 | $2,286.17 |
- 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
- $899.00 / $1,142.32 / $5,464.90
| Professional | | $899.00 | $1,142.32 | $5,464.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.70 / $945.70 / $2,207.69
| Professional | | $945.70 | $945.70 | $2,207.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,249.74 / $1,249.74 / $1,249.74
| Facility | | $1,249.74 | $1,249.74 | $1,249.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.80 / $1,236.01 / $2,123.09
| Professional | | $874.80 | $1,236.01 | $2,123.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.45 / $1,072.24 / $1,072.24
| Facility | | $1,019.45 | $1,072.24 | $1,072.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.45 / $1,072.24 / $1,140.53
| Professional | | $1,019.45 | $1,072.24 | $1,140.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $2,391.00 / $6,322.00
| Facility | | $448.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.37 / $1,278.61 / $2,133.92
| Professional | | $920.37 | $1,278.61 | $2,133.92 |