- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.48 / $3,766.00 / $13,004.00
| Facility | | $1,092.48 | $3,766.00 | $13,004.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.48 / $1,274.06 / $1,999.69
| Professional | | $1,092.48 | $1,274.06 | $1,999.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,686.50 / $4,799.47 / $8,904.69
| Facility | | $2,686.50 | $4,799.47 | $8,904.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.15 / $1,265.54 / $2,357.34
| Professional | | $919.15 | $1,265.54 | $2,357.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.14 / $1,047.14 / $1,047.14
| Facility | | $1,047.14 | $1,047.14 | $1,047.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.52 / $1,607.31 / $2,531.86
| Professional | | $1,231.52 | $1,607.31 | $2,531.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,159.60
| Facility | | $55.00 | $55.00 | $8,159.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,273.00 / $10,273.00 / $10,273.00
| Professional | | $10,273.00 | $10,273.00 | $10,273.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.81 / $1,573.04 / $2,630.56
| Facility | | $1,160.81 | $1,573.04 | $2,630.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,496.57 / $1,761.35 / $2,072.17
| Professional | | $1,496.57 | $1,761.35 | $2,072.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,069.19 / $2,069.19 / $2,069.19
| Professional | | $2,069.19 | $2,069.19 | $2,069.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.81 / $1,589.27 / $2,998.20
| Facility | | $1,160.81 | $1,589.27 | $2,998.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.52 / $1,638.03 / $2,652.05
| Professional | | $1,231.52 | $1,638.03 | $2,652.05 |
- 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
- $991.74 / $1,363.65 / $2,107.46
| Professional | | $991.74 | $1,363.65 | $2,107.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.52 / $1,125.43 / $1,553.92
| Professional | | $982.52 | $1,125.43 | $1,553.92 |