- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $3,742.00 / $13,004.00
| Facility | | $1,068.00 | $3,742.00 | $13,004.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.02 / $1,383.91 / $1,765.55
| Professional | | $1,193.02 | $1,383.91 | $1,765.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.31 / $1,438.63 / $1,966.45
| Professional | | $1,132.31 | $1,438.63 | $1,966.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.45 / $1,064.45 / $1,064.45
| Facility | | $1,064.45 | $1,064.45 | $1,064.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.80 / $1,623.34 / $2,580.17
| Professional | | $1,269.80 | $1,623.34 | $2,580.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,459.07
| Facility | | $55.00 | $55.00 | $15,459.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,887.92 / $9,082.40 / $10,504.20
| Professional | | $8,887.92 | $9,082.40 | $10,504.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.53 / $1,564.78 / $2,732.17
| Facility | | $1,267.53 | $1,564.78 | $2,732.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.32 / $1,810.76 / $2,172.91
| Professional | | $1,569.32 | $1,810.76 | $2,172.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.20 / $1,359.72 / $2,732.58
| Professional | | $1,144.20 | $1,359.72 | $2,732.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.53 / $1,598.65 / $3,178.40
| Facility | | $1,267.53 | $1,598.65 | $3,178.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.80 / $1,675.17 / $2,645.90
| Professional | | $1,269.80 | $1,675.17 | $2,645.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.64 / $1,353.20 / $2,160.63
| Professional | | $1,050.64 | $1,353.20 | $2,160.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.28 / $1,177.03 / $1,622.54
| Professional | | $1,030.28 | $1,177.03 | $1,622.54 |