- 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
- $636.01 / $863.50 / $2,241.38
| Professional | | $636.01 | $863.50 | $2,241.38 |
- 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
- $710.75 / $1,429.15 / $5,798.24
| Professional | | $710.75 | $1,429.15 | $5,798.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.67 / $1,235.86 / $2,180.84
| Facility | | $950.67 | $1,235.86 | $2,180.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.06 / $1,713.14 / $2,429.15
| Professional | | $1,290.06 | $1,713.14 | $2,429.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.41 / $1,406.21 / $3,023.12
| Professional | | $881.41 | $1,406.21 | $3,023.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $799.86 / $1,733.44 / $6,679.00
| Facility | | $799.86 | $1,733.44 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.78 / $1,301.55 / $1,796.64
| Professional | | $1,034.78 | $1,301.55 | $1,796.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.73 / $2,004.01 / $2,801.49
| Professional | | $986.73 | $2,004.01 | $2,801.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.40 / $4,232.85 / $29,336.93
| Facility | | $1,226.40 | $4,232.85 | $29,336.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.66 / $1,461.78 / $1,951.31
| Professional | | $975.66 | $1,461.78 | $1,951.31 |
- 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
- $959.72 / $1,756.62 / $6,747.84
| Professional | | $959.72 | $1,756.62 | $6,747.84 |
- 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
- $859.08 / $1,357.96 / $2,776.75
| Professional | | $859.08 | $1,357.96 | $2,776.75 |