- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.00 / $5,342.00 / $10,527.00
| Facility | | $1,519.00 | $5,342.00 | $10,527.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.66 / $1,783.58 / $3,412.95
| Professional | | $1,418.66 | $1,783.58 | $3,412.95 |
- 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
- $1,719.22 / $1,784.10 / $1,784.10
| Professional | | $1,719.22 | $1,784.10 | $1,784.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,491.54 / $2,085.91 / $3,457.71
| Professional | | $1,491.54 | $2,085.91 | $3,457.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,073.55 / $2,757.71 / $2,765.43
| Professional | | $2,073.55 | $2,757.71 | $2,765.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,495.40 / $19,950.39 / $82,994.42
| Facility | | $12,495.40 | $19,950.39 | $82,994.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.00 / $5,742.00 / $11,083.00
| Facility | | $1,459.00 | $5,742.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.28 / $1,875.94 / $7,028.00
| Professional | | $1,301.28 | $1,875.94 | $7,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,559.10 / $4,625.70
| Professional | | $5.00 | $1,559.10 | $4,625.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,524.87 / $2,108.48 / $3,530.89
| Professional | | $1,524.87 | $2,108.48 | $3,530.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.24 / $1,713.28 / $1,713.28
| Facility | | $1,534.24 | $1,713.28 | $1,713.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.24 / $1,713.28 / $1,829.08
| Professional | | $1,534.24 | $1,713.28 | $1,829.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,718.00 / $3,752.00 / $7,000.00
| Facility | | $1,718.00 | $3,752.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,398.83 / $2,091.44 / $3,419.47
| Professional | | $1,398.83 | $2,091.44 | $3,419.47 |