- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.15 / $2,447.48 / $4,410.00
| Facility | | $735.15 | $2,447.48 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.36 / $1,711.27 / $4,262.60
| Professional | | $1,488.36 | $1,711.27 | $4,262.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $5,499.17 / $13,940.55
| Facility | | $1,697.00 | $5,499.17 | $13,940.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.05 / $2,869.19 / $11,850.64
| Professional | | $1,603.05 | $2,869.19 | $11,850.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,318.44 / $3,168.35 / $4,292.03
| Professional | | $2,318.44 | $3,168.35 | $4,292.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,633.41 / $20,683.62 / $20,683.62
| Facility | | $20,633.41 | $20,683.62 | $20,683.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,675.53 / $2,756.47 / $4,734.22
| Professional | | $1,675.53 | $2,756.47 | $4,734.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.63 / $2,642.15 / $7,315.92
| Facility | | $1,636.63 | $2,642.15 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,878.03 / $2,274.92 / $3,100.12
| Professional | | $1,878.03 | $2,274.92 | $3,100.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,047.18 / $4,058.33 / $5,353.58
| Professional | | $2,047.18 | $4,058.33 | $5,353.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,232.45 / $12,232.45 / $42,660.90
| Facility | | $12,232.45 | $12,232.45 | $42,660.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.49 / $3,650.63 / $3,650.63
| Professional | | $381.49 | $3,650.63 | $3,650.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,904.00 / $15,421.00
| Facility | | $55.00 | $5,904.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,767.28 / $3,015.45 / $11,850.64
| Professional | | $1,767.28 | $3,015.45 | $11,850.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,883.00 / $15,421.00
| Facility | | $2,386.00 | $6,883.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,727.85 / $2,554.17 / $5,477.62
| Professional | | $1,727.85 | $2,554.17 | $5,477.62 |