- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.00 / $3,682.00 / $12,729.00
| Facility | | $1,002.00 | $3,682.00 | $12,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.31 / $1,430.45 / $2,283.44
| Professional | | $1,120.31 | $1,430.45 | $2,283.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,398.31 / $5,994.78 / $11,378.62
| Facility | | $3,398.31 | $5,994.78 | $11,378.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.70 / $1,474.26 / $2,019.17
| Professional | | $1,190.70 | $1,474.26 | $2,019.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,099.41 / $1,099.41 / $1,148.01
| Facility | | $1,099.41 | $1,099.41 | $1,148.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.10 / $1,628.10 / $1,628.10
| Professional | | $1,628.10 | $1,628.10 | $1,628.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $26,542.00 / $26,542.00
| Facility | | $11,500.00 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,591.60 / $9,867.04 / $10,852.43
| Professional | | $9,591.60 | $9,867.04 | $10,852.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.39 / $1,561.72 / $2,306.85
| Facility | | $1,242.39 | $1,561.72 | $2,306.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.29 / $1,908.77 / $5,478.00
| Professional | | $1,234.29 | $1,908.77 | $5,478.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.55 / $1,261.57 / $1,431.57
| Professional | | $1,183.55 | $1,261.57 | $1,431.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.39 / $1,585.58 / $2,468.51
| Facility | | $1,242.39 | $1,585.58 | $2,468.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.96 / $1,738.61 / $2,522.01
| Professional | | $1,232.96 | $1,738.61 | $2,522.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $5,530.00 / $13,134.00
| Facility | | $2,093.00 | $5,530.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.66 / $1,352.33 / $2,028.50
| Professional | | $1,024.66 | $1,352.33 | $2,028.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,086.05 / $1,234.29 / $1,725.02
| Professional | | $1,086.05 | $1,234.29 | $1,725.02 |