- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.00 / $3,111.85 / $8,272.00
| Facility | | $2,618.00 | $3,111.85 | $8,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.25 / $1,278.67 / $2,865.35
| Professional | | $1,012.25 | $1,278.67 | $2,865.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.00 / $5,097.00 / $22,645.14
| Facility | | $2,089.00 | $5,097.00 | $22,645.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.15 / $1,832.41 / $9,019.65
| Professional | | $1,052.15 | $1,832.41 | $9,019.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,650.66 / $17,326.48 / $22,567.54
| Facility | | $14,650.66 | $17,326.48 | $22,567.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,700.00 / $14,868.13 / $20,251.00
| Facility | | $3,700.00 | $14,868.13 | $20,251.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,986.00 / $2,281.92 / $3,620.57
| Professional | | $1,986.00 | $2,281.92 | $3,620.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.08 / $1,676.06 / $8,090.00
| Facility | | $1,046.08 | $1,676.06 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.84 / $1,238.36 / $1,935.27
| Professional | | $664.84 | $1,238.36 | $1,935.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,322.19 / $2,644.38 / $4,297.12
| Professional | | $1,322.19 | $2,644.38 | $4,297.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,440.90 / $24,440.90 / $24,440.90
| Facility | | $24,440.90 | $24,440.90 | $24,440.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,883.00 / $14,018.00
| Facility | | $2,386.00 | $6,883.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.02 / $2,261.77 / $9,019.65
| Professional | | $1,256.02 | $2,261.77 | $9,019.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.80 / $1,779.14 / $3,556.37
| Professional | | $1,217.80 | $1,779.14 | $3,556.37 |