- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.71 / $3,854.75 / $12,210.50
| Facility | | $2,088.71 | $3,854.75 | $12,210.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.07 / $2,364.88 / $2,919.60
| Professional | | $719.07 | $2,364.88 | $2,919.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $13,055.28 / $19,843.65
| Facility | | $8,639.91 | $13,055.28 | $19,843.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,277.29 / $2,277.29 / $2,311.44
| Professional | | $2,277.29 | $2,277.29 | $2,311.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,954.67 / $3,795.48 / $8,539.83
| Facility | | $1,954.67 | $3,795.48 | $8,539.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.17 / $3,125.21 / $6,603.01
| Professional | | $1,537.17 | $3,125.21 | $6,603.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.02 / $2,335.67 / $4,934.12
| Professional | | $1,343.02 | $2,335.67 | $4,934.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.11 / $4,450.00 / $7,663.95
| Facility | | $2,100.11 | $4,450.00 | $7,663.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,102.11 / $6,834.50 / $12,057.90
| Facility | | $2,102.11 | $6,834.50 | $12,057.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,880.00 / $2,481.66 / $12,057.90
| Professional | | $1,880.00 | $2,481.66 | $12,057.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,321.01 / $4,379.39 / $5,839.20
| Professional | | $4,321.01 | $4,379.39 | $5,839.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,040.13 / $4,519.27 / $9,688.16
| Facility | | $2,040.13 | $4,519.27 | $9,688.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,751.76 / $3,296.16 / $6,603.01
| Professional | | $1,751.76 | $3,296.16 | $6,603.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.60 / $2,919.60 / $3,211.56
| Facility | | $2,919.60 | $2,919.60 | $3,211.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $2,919.60 / $3,211.56
| Professional | | $2,919.60 | $2,919.60 | $3,211.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $4,963.32
| Professional | | $1,226.23 | $1,751.76 | $4,963.32 |