- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.45 / $3,111.85 / $8,271.00
| Facility | | $1,534.45 | $3,111.85 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.77 / $701.25 / $1,624.31
| Professional | | $530.77 | $701.25 | $1,624.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.31 / $3,592.00 / $10,821.00
| Facility | | $956.31 | $3,592.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.54 / $1,290.00 / $5,333.92
| Professional | | $637.54 | $1,290.00 | $5,333.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.24 / $877.96 / $1,567.35
| Facility | | $683.24 | $877.96 | $1,567.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.38 / $1,460.93 / $1,979.18
| Professional | | $1,120.38 | $1,460.93 | $1,979.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.82 / $1,125.08 / $2,080.94
| Professional | | $661.82 | $1,125.08 | $2,080.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.91 / $1,245.82 / $7,315.92
| Facility | | $574.91 | $1,245.82 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.29 / $1,035.61 / $1,429.56
| Professional | | $852.29 | $1,035.61 | $1,429.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.17 / $1,538.75 / $2,124.17
| Professional | | $727.17 | $1,538.75 | $2,124.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.56 / $7,175.92 / $7,900.69
| Facility | | $402.56 | $7,175.92 | $7,900.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.28 / $901.28 / $1,802.56
| Professional | | $901.28 | $901.28 | $1,802.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,672.00 / $26,542.00
| Facility | | $1,640.00 | $3,672.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.70 / $1,564.31 / $5,333.92
| Professional | | $797.70 | $1,564.31 | $5,333.92 |
- 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
- $761.29 / $1,137.15 / $2,218.50
| Professional | | $761.29 | $1,137.15 | $2,218.50 |