- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.72 / $1,825.96 / $10,561.00
| Facility | | $1,196.72 | $1,825.96 | $10,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.15 / $1,253.94 / $2,329.19
| Professional | | $1,102.15 | $1,253.94 | $2,329.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,579.72 / $7,579.72 / $7,690.32
| Facility | | $7,579.72 | $7,579.72 | $7,690.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.12 / $1,994.93 / $3,242.45
| Professional | | $1,313.12 | $1,994.93 | $3,242.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,637.23
| Facility | | $606.10 | $606.10 | $7,637.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.26 / $1,702.74 / $3,083.88
| Professional | | $1,249.26 | $1,702.74 | $3,083.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.72 / $1,555.74 / $2,219.91
| Facility | | $1,196.72 | $1,555.74 | $2,219.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,480.53 / $1,504.00 / $1,580.00
| Professional | | $1,480.53 | $1,504.00 | $1,580.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,766.36 / $3,219.80
| Professional | | $3.00 | $1,766.36 | $3,219.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.72 / $1,416.30 / $2,908.25
| Professional | | $1,027.72 | $1,416.30 | $2,908.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $22,030.06 / $25,239.65
| Facility | | $55.00 | $22,030.06 | $25,239.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,845.20 / $8,845.20 / $10,541.78
| Professional | | $8,845.20 | $8,845.20 | $10,541.78 |