- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.00 / $3,762.00 / $13,401.00
| Facility | | $1,051.00 | $3,762.00 | $13,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.76 / $1,995.23 / $3,226.10
| Professional | | $1,627.76 | $1,995.23 | $3,226.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.86 / $3,950.90 / $9,413.77
| Facility | | $2,187.86 | $3,950.90 | $9,413.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,943.90 / $2,037.06
| Facility | | $80.00 | $1,943.90 | $2,037.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.28 / $2,326.28 / $2,326.28
| Facility | | $2,326.28 | $2,326.28 | $2,326.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,866.39 / $2,472.09 / $3,808.35
| Professional | | $1,866.39 | $2,472.09 | $3,808.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $32,143.44
| Facility | | $55.00 | $55.00 | $32,143.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,120.80 / $14,438.08 / $18,306.30
| Professional | | $14,120.80 | $14,438.08 | $18,306.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,728.21 / $2,273.13 / $4,173.00
| Facility | | $1,728.21 | $2,273.13 | $4,173.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,518.58 / $3,022.29 / $3,747.64
| Professional | | $2,518.58 | $3,022.29 | $3,747.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.46 / $3,433.84 / $7,557.85
| Professional | | $2,321.46 | $3,433.84 | $7,557.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,728.21 / $2,280.94 / $4,546.46
| Facility | | $1,728.21 | $2,280.94 | $4,546.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.40 / $2,557.13 / $4,003.21
| Professional | | $1,949.40 | $2,557.13 | $4,003.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $9,027.00 / $20,955.00
| Facility | | $4,600.00 | $9,027.00 | $20,955.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.40 / $2,085.63 / $3,273.91
| Professional | | $1,509.40 | $2,085.63 | $3,273.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,719.62 / $1,949.96 / $2,678.33
| Professional | | $1,719.62 | $1,949.96 | $2,678.33 |