- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.00 / $4,990.00 / $10,398.00
| Facility | | $1,519.00 | $4,990.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,259.83 / $1,624.60 / $2,113.50
| Professional | | $1,259.83 | $1,624.60 | $2,113.50 |
- 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
- $1,575.20 / $1,634.64 / $1,634.64
| Professional | | $1,575.20 | $1,634.64 | $1,634.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.09 / $2,009.74 / $3,262.59
| Professional | | $1,469.09 | $2,009.74 | $3,262.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,892.04 / $2,517.07 / $2,517.07
| Professional | | $1,892.04 | $2,517.07 | $2,517.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,208.26 / $11,208.26 / $11,208.26
| Facility | | $11,208.26 | $11,208.26 | $11,208.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.00 / $5,526.00 / $11,043.00
| Facility | | $1,426.00 | $5,526.00 | $11,043.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.29 / $1,719.16 / $5,958.00
| Professional | | $1,424.29 | $1,719.16 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,726.40 / $4,165.30
| Professional | | $5.00 | $1,726.40 | $4,165.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,527.41 / $2,040.21 / $3,447.06
| Professional | | $1,527.41 | $2,040.21 | $3,447.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,562.52 / $1,562.52 / $1,641.14
| Facility | | $1,562.52 | $1,562.52 | $1,641.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.79 / $1,564.76 / $1,661.33
| Professional | | $1,519.79 | $1,564.76 | $1,661.33 |
- 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
- $1,345.34 / $1,858.46 / $3,296.45
| Professional | | $1,345.34 | $1,858.46 | $3,296.45 |