- 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
- $1,393.54 / $1,537.70 / $2,207.77
| Professional | | $1,393.54 | $1,537.70 | $2,207.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,636.44 / $1,698.19 / $1,698.19
| Professional | | $1,636.44 | $1,698.19 | $1,698.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.81 / $2,084.14 / $3,426.25
| Professional | | $1,543.81 | $2,084.14 | $3,426.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,046.64 / $2,770.97 / $2,770.97
| Professional | | $2,046.64 | $2,770.97 | $2,770.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,032.79 / $25,032.79 / $25,032.79
| Facility | | $25,032.79 | $25,032.79 | $25,032.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.54 / $1,670.19 / $5,958.00
| Professional | | $1,393.54 | $1,670.19 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $1,841.00 / $4,069.10
| Professional | | $11.00 | $1,841.00 | $4,069.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,581.61 / $2,082.40 / $3,459.98
| Professional | | $1,581.61 | $2,082.40 | $3,459.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.93 / $1,593.61 / $1,593.61
| Facility | | $1,367.93 | $1,593.61 | $1,593.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,367.93 / $1,593.61 / $1,691.49
| Professional | | $1,367.93 | $1,593.61 | $1,691.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.92 / $2,166.32 / $3,245.68
| Professional | | $1,556.92 | $2,166.32 | $3,245.68 |