- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.08 / $5,254.00 / $10,527.00
| Facility | | $1,272.08 | $5,254.00 | $10,527.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.52 / $916.11 / $2,081.92
| Professional | | $781.52 | $916.11 | $2,081.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,682.80 / $1,682.80 / $1,682.80
| Professional | | $1,682.80 | $1,682.80 | $1,682.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,459.92 / $25,716.00 / $39,341.64
| Facility | | $8,459.92 | $25,716.00 | $39,341.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.58 / $1,278.97 / $1,709.76
| Professional | | $811.58 | $1,278.97 | $1,709.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.00 / $1,187.55 / $1,884.05
| Professional | | $868.00 | $1,187.55 | $1,884.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.31 / $1,445.50 / $1,445.50
| Professional | | $1,087.31 | $1,445.50 | $1,445.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,113.03 / $7,233.20 / $11,800.98
| Facility | | $7,113.03 | $7,233.20 | $11,800.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.68 / $5,526.00 / $11,083.00
| Facility | | $1,310.68 | $5,526.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.63 / $1,022.20 / $2,546.78
| Professional | | $813.63 | $1,022.20 | $2,546.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,229.40 / $2,362.90
| Professional | | $6.00 | $1,229.40 | $2,362.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $877.50 / $1,201.36 / $1,941.30
| Professional | | $877.50 | $1,201.36 | $1,941.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.89 / $919.89 / $929.83
| Facility | | $919.89 | $919.89 | $929.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.63 / $927.64 / $966.83
| Professional | | $888.63 | $927.64 | $966.83 |
- 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
- $874.38 / $1,171.18 / $1,825.60
| Professional | | $874.38 | $1,171.18 | $1,825.60 |