- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.43 / $3,895.00 / $13,401.00
| Facility | | $1,045.43 | $3,895.00 | $13,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.75 / $1,152.26 / $1,943.83
| Professional | | $961.75 | $1,152.26 | $1,943.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.12 / $9,152.37 / $17,945.84
| Facility | | $5,264.12 | $9,152.37 | $17,945.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.66 / $1,292.20 / $1,812.49
| Professional | | $1,043.66 | $1,292.20 | $1,812.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,017.13 / $1,039.70
| Facility | | $80.00 | $1,017.13 | $1,039.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,294.18 / $1,294.18 / $1,294.18
| Facility | | $1,294.18 | $1,294.18 | $1,294.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.00 / $1,524.33 / $2,340.46
| Professional | | $1,142.00 | $1,524.33 | $2,340.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,381.42 / $19,913.50 / $26,542.00
| Facility | | $6,381.42 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,602.26 / $8,602.26 / $9,775.58
| Professional | | $8,602.26 | $8,602.26 | $9,775.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.84 / $1,419.43 / $2,203.94
| Facility | | $1,106.84 | $1,419.43 | $2,203.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,398.59 / $1,678.31 / $2,081.10
| Professional | | $1,398.59 | $1,678.31 | $2,081.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.11 / $1,915.91 / $4,101.34
| Professional | | $1,226.11 | $1,915.91 | $4,101.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.84 / $1,426.99 / $2,310.88
| Facility | | $1,106.84 | $1,426.99 | $2,310.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.45 / $1,592.68 / $2,377.17
| Professional | | $1,164.45 | $1,592.68 | $2,377.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,002.00 / $13,237.00
| Facility | | $2,093.00 | $6,002.00 | $13,237.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.48 / $1,236.27 / $1,920.44
| Professional | | $912.48 | $1,236.27 | $1,920.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.92 / $1,085.94 / $1,504.78
| Professional | | $954.92 | $1,085.94 | $1,504.78 |