- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.09 / $2,663.12 / $4,410.00
| Facility | | $853.09 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.94 / $1,089.28 / $2,362.53
| Professional | | $759.94 | $1,089.28 | $2,362.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,815.89 / $9,401.00
| Facility | | $1,672.00 | $5,815.89 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.48 / $1,704.44 / $7,226.24
| Professional | | $853.48 | $1,704.44 | $7,226.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.70 / $1,528.41 / $2,697.06
| Facility | | $1,175.70 | $1,528.41 | $2,697.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,484.91 / $2,103.33 / $2,905.39
| Professional | | $1,484.91 | $2,103.33 | $2,905.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.39 / $1,687.82 / $3,767.71
| Professional | | $1,109.39 | $1,687.82 | $3,767.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.78 / $1,909.00 / $6,679.00
| Facility | | $993.78 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,240.72 / $1,552.26 / $2,142.73
| Professional | | $1,240.72 | $1,552.26 | $2,142.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.49 / $2,470.33 / $3,453.22
| Professional | | $1,232.49 | $2,470.33 | $3,453.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.77 / $745.00 / $1,533.36
| Facility | | $643.77 | $745.00 | $1,533.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,875.68 / $2,875.68 / $2,875.68
| Professional | | $2,875.68 | $2,875.68 | $2,875.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,404.00 / $26,542.00
| Facility | | $2,155.00 | $6,404.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.09 / $2,014.90 / $8,123.28
| Professional | | $1,200.09 | $2,014.90 | $8,123.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.96 / $1,540.24 / $3,183.80
| Professional | | $1,063.96 | $1,540.24 | $3,183.80 |