- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.00 / $4,894.00 / $8,933.00
| Facility | | $1,426.00 | $4,894.00 | $8,933.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.46 / $1,366.26 / $1,760.34
| Professional | | $1,097.46 | $1,366.26 | $1,760.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.16 / $1,357.52 / $1,357.52
| Professional | | $1,308.16 | $1,357.52 | $1,357.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.39 / $1,591.54 / $2,610.78
| Professional | | $1,126.39 | $1,591.54 | $2,610.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,585.52 / $2,107.96 / $2,127.80
| Professional | | $1,585.52 | $2,107.96 | $2,127.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,611.71 / $5,611.71 / $5,611.71
| Facility | | $5,611.71 | $5,611.71 | $5,611.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $5,350.00 / $9,734.00
| Facility | | $1,151.00 | $5,350.00 | $9,734.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.39 / $1,426.00 / $3,679.33
| Professional | | $1,102.39 | $1,426.00 | $3,679.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,083.90 / $3,590.70
| Professional | | $5.00 | $1,083.90 | $3,590.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.33 / $1,604.35 / $2,632.69
| Professional | | $1,150.33 | $1,604.35 | $2,632.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.97 / $1,309.82 / $1,309.82
| Facility | | $1,164.97 | $1,309.82 | $1,309.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.97 / $1,309.82 / $1,404.98
| Professional | | $1,164.97 | $1,309.82 | $1,404.98 |
- 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
- $1,046.09 / $1,557.93 / $2,573.16
| Professional | | $1,046.09 | $1,557.93 | $2,573.16 |