- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.45 / $4,761.00 / $19,167.25
| Facility | | $1,229.45 | $4,761.00 | $19,167.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.83 / $1,220.42 / $1,499.69
| Professional | | $1,022.83 | $1,220.42 | $1,499.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.73 / $1,618.37 / $2,177.86
| Professional | | $1,015.73 | $1,618.37 | $2,177.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.47 / $1,496.94 / $2,348.82
| Professional | | $1,111.47 | $1,496.94 | $2,348.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.28 / $1,770.31 / $1,775.19
| Professional | | $1,338.28 | $1,770.31 | $1,775.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,451.55 / $18,451.55 / $18,451.55
| Facility | | $18,451.55 | $18,451.55 | $18,451.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $5,342.00 / $10,527.00
| Facility | | $1,013.00 | $5,342.00 | $10,527.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.83 / $1,239.83 / $2,338.58
| Professional | | $1,022.83 | $1,239.83 | $2,338.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,456.30 / $2,853.10
| Professional | | $7.00 | $1,456.30 | $2,853.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.54 / $1,502.15 / $2,390.19
| Professional | | $1,121.54 | $1,502.15 | $2,390.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.69 / $1,119.69 / $1,331.38
| Facility | | $1,119.69 | $1,119.69 | $1,331.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.10 / $1,125.85 / $1,331.38
| Professional | | $1,085.10 | $1,125.85 | $1,331.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,222.00 / $3,475.00 / $6,000.00
| Facility | | $2,222.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.57 / $1,448.05 / $2,343.71
| Professional | | $1,112.57 | $1,448.05 | $2,343.71 |