- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,434.80 / $9,639.00 / $20,509.00
| Facility | | $1,434.80 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.77 / $1,376.84 / $6,725.69
| Professional | | $1,217.77 | $1,376.84 | $6,725.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,446.00 / $10,450.00 / $21,131.00
| Facility | | $4,446.00 | $10,450.00 | $21,131.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.66 / $1,912.18 / $3,718.77
| Professional | | $1,462.66 | $1,912.18 | $3,718.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.20 / $100.00 / $5,717.48
| Facility | | $64.20 | $100.00 | $5,717.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.52 / $1,376.62 / $3,383.57
| Professional | | $894.52 | $1,376.62 | $3,383.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.79 / $1,670.08 / $5,080.68
| Professional | | $1,236.79 | $1,670.08 | $5,080.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.03 / $1,412.18 / $1,694.62
| Professional | | $1,064.03 | $1,412.18 | $1,694.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,270.96 / $1,625.26 / $2,888.53
| Professional | | $1,270.96 | $1,625.26 | $2,888.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $8,193.36 / $10,372.25
| Facility | | $55.00 | $8,193.36 | $10,372.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,527.44 / $10,527.44 / $10,558.05
| Professional | | $10,527.44 | $10,527.44 | $10,558.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.97 / $1,664.92 / $2,290.54
| Facility | | $1,312.97 | $1,664.92 | $2,290.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.46 / $1,676.62 / $3,618.54
| Professional | | $1,257.46 | $1,676.62 | $3,618.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,173.17 / $4,173.17 / $4,173.17
| Professional | | $4,173.17 | $4,173.17 | $4,173.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.03 / $1,489.65 / $1,808.86
| Professional | | $1,064.03 | $1,489.65 | $1,808.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.00 / $2,849.00 / $9,553.00
| Facility | | $1,437.00 | $2,849.00 | $9,553.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.48 / $1,562.16 / $4,302.47
| Professional | | $1,061.48 | $1,562.16 | $4,302.47 |