- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.00 / $2,447.48 / $4,410.00
| Facility | | $1,015.00 | $2,447.48 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.82 / $945.38 / $2,551.94
| Professional | | $628.82 | $945.38 | $2,551.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,315.28 / $8,498.00
| Facility | | $1,089.00 | $3,315.28 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.25 / $1,535.34 / $5,969.04
| Professional | | $760.25 | $1,535.34 | $5,969.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.43 / $1,262.85 / $2,228.46
| Facility | | $971.43 | $1,262.85 | $2,228.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.23 / $1,916.20 / $2,617.13
| Professional | | $1,318.23 | $1,916.20 | $2,617.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.63 / $1,484.34 / $3,092.32
| Professional | | $938.63 | $1,484.34 | $3,092.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.87 / $1,771.30 / $6,679.00
| Facility | | $819.87 | $1,771.30 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.64 / $1,398.25 / $1,930.14
| Professional | | $1,112.64 | $1,398.25 | $1,930.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.53 / $2,086.52 / $2,940.21
| Professional | | $1,012.53 | $2,086.52 | $2,940.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,961.51 / $2,077.98 / $4,580.53
| Facility | | $1,961.51 | $2,077.98 | $4,580.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,525.23 / $1,613.51 / $2,468.42
| Professional | | $1,525.23 | $1,613.51 | $2,468.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $4,569.00 / $26,542.00
| Facility | | $1,640.00 | $4,569.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.23 / $1,909.37 / $7,269.36
| Professional | | $1,088.23 | $1,909.37 | $7,269.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.26 / $1,415.29 / $2,694.70
| Professional | | $914.26 | $1,415.29 | $2,694.70 |