- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,255.59 / $5,254.00 / $10,398.00
| Facility | | $1,255.59 | $5,254.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.30 / $1,186.65 / $1,885.40
| Professional | | $1,050.30 | $1,186.65 | $1,885.40 |
- 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
- $1,188.09 / $1,232.94 / $2,194.16
| Professional | | $1,188.09 | $1,232.94 | $2,194.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.72 / $1,306.01 / $2,183.42
| Professional | | $1,011.72 | $1,306.01 | $2,183.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,420.01 / $1,825.73 / $1,889.52
| Professional | | $1,420.01 | $1,825.73 | $1,889.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.02 / $784.02 / $784.02
| Facility | | $784.02 | $784.02 | $784.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $5,526.00 / $11,083.00
| Facility | | $1,301.00 | $5,526.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.81 / $1,255.64 / $6,296.01
| Professional | | $1,051.81 | $1,255.64 | $6,296.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.10 / $1,327.10 / $1,395.00
| Professional | | $1,327.10 | $1,327.10 | $1,395.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.26 / $1,340.26 / $1,340.26
| Facility | | $1,340.26 | $1,340.26 | $1,340.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.08 / $1,363.33 / $2,366.36
| Professional | | $1,052.08 | $1,363.33 | $2,366.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.20 / $1,161.20 / $1,446.75
| Facility | | $1,161.20 | $1,161.20 | $1,446.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.20 / $1,166.90 / $1,446.75
| Professional | | $1,161.20 | $1,166.90 | $1,446.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.00 / $3,879.00 / $7,508.00
| Facility | | $1,843.00 | $3,879.00 | $7,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.55 / $1,326.28 / $2,293.42
| Professional | | $1,030.55 | $1,326.28 | $2,293.42 |