- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,630.78 / $12,022.64
| Facility | | $912.01 | $3,630.78 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,000.00 / $1,621.81
| Professional | | $831.76 | $1,000.00 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $8,709.64
| Facility | | $2,570.40 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,096.48 / $1,479.11
| Professional | | $870.96 | $1,096.48 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $912.01 / $912.01
| Facility | | $79.43 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $4,570.88
| Professional | | $1,905.46 | $2,344.23 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $45,708.82 / $45,708.82
| Facility | | $8,912.51 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,317.64 / $8,317.64
| Professional | | $6,918.31 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,258.93 / $3,890.45
| Facility | | $891.25 | $1,258.93 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $1,737.80
| Professional | | $870.96 | $1,230.27 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $891.25
| Professional | | $32.36 | $33.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,819.70
| Professional | | $1,122.02 | $1,122.02 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,949.84
| Facility | | $912.01 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,698.24 / $2,187.76
| Professional | | $79.43 | $1,698.24 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $10,964.78
| Facility | | $1,698.24 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,513.56
| Professional | | $741.31 | $977.24 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $954.99 / $954.99
| Professional | | $912.01 | $954.99 | $954.99 |