- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.39 / $4,993.00 / $8,427.00
| Facility | | $1,272.39 | $4,993.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.53 / $1,385.86 / $1,880.30
| Professional | | $1,147.53 | $1,385.86 | $1,880.30 |
- 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
- $1,463.31 / $1,518.53 / $1,518.53
| Professional | | $1,463.31 | $1,518.53 | $1,518.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.67 / $1,688.68 / $2,705.32
| Professional | | $1,182.67 | $1,688.68 | $2,705.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,742.43 / $2,310.98 / $2,331.12
| Professional | | $1,742.43 | $2,310.98 | $2,331.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,495.40 / $12,495.40 / $12,495.40
| Facility | | $12,495.40 | $12,495.40 | $12,495.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.39 / $4,993.00 / $9,617.00
| Facility | | $1,272.39 | $4,993.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.38 / $1,475.95 / $4,692.45
| Professional | | $1,162.38 | $1,475.95 | $4,692.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,551.80 / $3,855.30
| Professional | | $5.00 | $1,551.80 | $3,855.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.04 / $1,720.23 / $2,825.47
| Professional | | $1,280.04 | $1,720.23 | $2,825.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.88 / $1,183.79 / $1,447.47
| Facility | | $1,151.88 | $1,183.79 | $1,447.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.88 / $1,246.45 / $1,536.70
| Professional | | $1,151.88 | $1,246.45 | $1,536.70 |
- 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
- $1,296.44 / $1,854.21 / $2,914.85
| Professional | | $1,296.44 | $1,854.21 | $2,914.85 |