- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,247.00
| Facility | | $1,020.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.25 / $1,319.05 / $1,657.26
| Professional | | $1,140.25 | $1,319.05 | $1,657.26 |
- 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
- $1,302.41 / $1,351.56 / $1,351.56
| Professional | | $1,302.41 | $1,351.56 | $1,351.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.72 / $1,685.45 / $2,676.85
| Professional | | $1,256.72 | $1,685.45 | $2,676.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.68 / $2,001.01 / $2,005.38
| Professional | | $1,512.68 | $2,001.01 | $2,005.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,824.26 / $31,824.26 / $31,824.26
| Facility | | $31,824.26 | $31,824.26 | $31,824.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,247.00
| Facility | | $1,013.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.03 / $1,336.82 / $3,348.61
| Professional | | $1,152.03 | $1,336.82 | $3,348.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,717.60 / $3,224.70
| Professional | | $7.00 | $1,717.60 | $3,224.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.58 / $1,698.45 / $2,750.76
| Professional | | $1,278.58 | $1,698.45 | $2,750.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.59 / $1,266.59 / $1,642.35
| Facility | | $1,266.59 | $1,266.59 | $1,642.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.14 / $1,273.93 / $1,642.35
| Professional | | $1,227.14 | $1,273.93 | $1,642.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.16 / $1,575.81 / $2,647.11
| Professional | | $1,137.16 | $1,575.81 | $2,647.11 |