- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.00 / $4,469.01 / $10,600.00
| Facility | | $1,426.00 | $4,469.01 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.72 / $3,374.21 / $4,484.20
| Professional | | $757.72 | $3,374.21 | $4,484.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $26,582.19
| Facility | | $8,639.91 | $11,851.00 | $26,582.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,837.97 / $3,982.80 / $3,982.80
| Professional | | $3,837.97 | $3,982.80 | $3,982.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.47 / $1,349.47 / $1,349.47
| Facility | | $1,349.47 | $1,349.47 | $1,349.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.09 / $2,947.14 / $6,512.32
| Professional | | $806.09 | $2,947.14 | $6,512.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,694.80 / $6,260.19 / $8,109.20
| Professional | | $4,694.80 | $6,260.19 | $8,109.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,850.90 / $12,495.40 / $16,066.13
| Facility | | $11,850.90 | $12,495.40 | $16,066.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.00 / $5,511.00 / $11,182.00
| Facility | | $1,459.00 | $5,511.00 | $11,182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.14 / $3,374.21 / $7,188.00
| Professional | | $766.14 | $3,374.21 | $7,188.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.40 / $952.40 / $9,227.40
| Professional | | $952.40 | $952.40 | $9,227.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.47 / $1,349.47 / $1,349.47
| Facility | | $1,349.47 | $1,349.47 | $1,349.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.27 / $2,989.84 / $6,721.13
| Professional | | $807.27 | $2,989.84 | $6,721.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.53 / $1,877.80 / $3,925.36
| Facility | | $766.53 | $1,877.80 | $3,925.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.64 / $2,881.40 / $4,284.62
| Professional | | $765.64 | $2,881.40 | $4,284.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,879.00 / $7,508.00
| Facility | | $2,332.00 | $3,879.00 | $7,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,095.79 / $4,589.56 / $7,996.57
| Professional | | $3,095.79 | $4,589.56 | $7,996.57 |