- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.00 / $4,894.00 / $8,451.00
| Facility | | $1,426.00 | $4,894.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.81 / $1,442.16 / $2,360.77
| Professional | | $1,023.81 | $1,442.16 | $2,360.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,800.00 / $11,479.00 / $17,952.00
| Facility | | $5,800.00 | $11,479.00 | $17,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.47 / $1,435.68 / $1,435.68
| Professional | | $1,383.47 | $1,435.68 | $1,435.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.44 / $1,648.00 / $2,658.03
| Professional | | $1,180.44 | $1,648.00 | $2,658.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.89 / $2,226.92 / $2,244.63
| Professional | | $1,674.89 | $2,226.92 | $2,244.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,464.00 / $18,299.25 / $154,808.79
| Facility | | $4,464.00 | $18,299.25 | $154,808.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $5,350.00 / $9,617.00
| Facility | | $1,151.00 | $5,350.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.94 / $1,550.90 / $3,874.45
| Professional | | $1,170.94 | $1,550.90 | $3,874.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,201.90 / $3,778.80
| Professional | | $5.00 | $1,201.90 | $3,778.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.02 / $1,674.20 / $2,731.91
| Professional | | $1,201.02 | $1,674.20 | $2,731.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.29 / $1,383.64 / $1,383.64
| Facility | | $1,266.29 | $1,383.64 | $1,383.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.29 / $1,383.64 / $1,482.56
| Professional | | $1,266.29 | $1,383.64 | $1,482.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.94 / $1,598.72 / $2,765.63
| Professional | | $1,132.94 | $1,598.72 | $2,765.63 |