- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.00 / $5,254.00 / $10,398.00
| Facility | | $1,462.00 | $5,254.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.42 / $1,545.06 / $2,020.92
| Professional | | $1,426.42 | $1,545.06 | $2,020.92 |
- 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
- $1,378.93 / $2,152.34 / $2,908.94
| Professional | | $1,378.93 | $2,152.34 | $2,908.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.64 / $2,017.60 / $3,239.69
| Professional | | $1,482.64 | $2,017.60 | $3,239.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,865.88 / $2,475.21 / $2,499.08
| Professional | | $1,865.88 | $2,475.21 | $2,499.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,495.40 / $12,495.40 / $12,495.40
| Facility | | $12,495.40 | $12,495.40 | $12,495.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.00 / $5,511.00 / $11,083.00
| Facility | | $1,426.00 | $5,511.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.42 / $1,647.51 / $7,188.00
| Professional | | $1,426.42 | $1,647.51 | $7,188.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,676.50 / $4,163.50
| Professional | | $5.00 | $1,676.50 | $4,163.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.54 / $2,041.30 / $3,406.34
| Professional | | $1,519.54 | $2,041.30 | $3,406.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.16 / $1,557.16 / $1,665.85
| Facility | | $1,557.16 | $1,557.16 | $1,665.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,520.01 / $1,557.16 / $1,665.85
| Professional | | $1,520.01 | $1,557.16 | $1,665.85 |
- 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
- $1,352.15 / $1,890.49 / $3,073.78
| Professional | | $1,352.15 | $1,890.49 | $3,073.78 |