- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $3,839.00 / $8,451.00
| Facility | | $1,151.00 | $3,839.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.91 / $1,023.63 / $1,673.84
| Professional | | $940.91 | $1,023.63 | $1,673.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.96 / $1,090.61 / $1,090.61
| Professional | | $1,050.96 | $1,090.61 | $1,090.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.74 / $1,187.74 / $1,187.74
| Facility | | $1,187.74 | $1,187.74 | $1,187.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.60 / $1,218.07 / $2,036.41
| Professional | | $891.60 | $1,218.07 | $2,036.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.85 / $1,685.20 / $2,146.75
| Professional | | $1,242.85 | $1,685.20 | $2,146.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.50 / $4,327.09 / $10,680.90
| Facility | | $0.50 | $4,327.09 | $10,680.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,787.25 / $4,787.25 / $4,787.25
| Professional | | $4,787.25 | $4,787.25 | $4,787.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $4,894.00 / $10,247.00
| Facility | | $1,151.00 | $4,894.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.91 / $1,171.47 / $2,843.00
| Professional | | $940.91 | $1,171.47 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.20 / $822.20 / $2,145.40
| Professional | | $822.20 | $822.20 | $2,145.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.74 / $1,187.74 / $1,187.74
| Facility | | $1,187.74 | $1,187.74 | $1,187.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.46 / $1,260.21 / $2,063.19
| Professional | | $903.46 | $1,260.21 | $2,063.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.15 / $1,022.39 / $1,022.39
| Facility | | $993.15 | $1,022.39 | $1,022.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.77 / $1,022.39 / $1,083.74
| Professional | | $990.77 | $1,022.39 | $1,083.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.66 / $1,209.26 / $1,969.19
| Professional | | $859.66 | $1,209.26 | $1,969.19 |