- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.41 / $5,254.00 / $10,398.00
| Facility | | $1,339.41 | $5,254.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.45 / $1,185.51 / $1,557.83
| Professional | | $1,104.45 | $1,185.51 | $1,557.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.49 / $1,652.44 / $2,226.00
| Professional | | $1,063.49 | $1,652.44 | $2,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.11 / $1,535.15 / $2,523.01
| Professional | | $1,132.11 | $1,535.15 | $2,523.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,447.92 / $1,920.95 / $1,949.12
| Professional | | $1,447.92 | $1,920.95 | $1,949.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,306.10 / $13,306.10 / $13,306.10
| Facility | | $13,306.10 | $13,306.10 | $13,306.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.41 / $5,511.00 / $11,083.00
| Facility | | $1,339.41 | $5,511.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.45 / $1,269.67 / $6,362.35
| Professional | | $1,104.45 | $1,269.67 | $6,362.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,204.80 / $3,266.60
| Professional | | $5.00 | $1,204.80 | $3,266.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.30 / $1,577.41 / $2,543.12
| Professional | | $1,173.30 | $1,577.41 | $2,543.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.01 / $1,204.01 / $1,220.59
| Facility | | $1,204.01 | $1,204.01 | $1,220.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,178.67 / $1,204.01 / $1,286.83
| Professional | | $1,178.67 | $1,204.01 | $1,286.83 |
- 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
- $1,010.33 / $1,477.39 / $2,346.76
| Professional | | $1,010.33 | $1,477.39 | $2,346.76 |