- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.75 / $8,491.18 / $20,400.00
| Facility | | $1,051.75 | $8,491.18 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.51 / $2,104.09 / $4,378.54
| Professional | | $391.51 | $2,104.09 | $4,378.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.01 / $2,134.57 / $6,186.00
| Professional | | $688.01 | $2,134.57 | $6,186.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.07 / $1,190.17 / $5,389.14
| Professional | | $810.07 | $1,190.17 | $5,389.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.90 / $2,048.19 / $6,219.45
| Facility | | $585.90 | $2,048.19 | $6,219.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.17 / $3,444.08 / $6,846.41
| Professional | | $691.17 | $3,444.08 | $6,846.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.80 / $4,242.47 / $4,816.43
| Facility | | $830.80 | $4,242.47 | $4,816.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.90 / $3,537.73 / $6,219.45
| Facility | | $585.90 | $3,537.73 | $6,219.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.60 / $2,892.46 / $6,694.19
| Professional | | $825.60 | $2,892.46 | $6,694.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,928.04 / $36,273.58 / $43,569.74
| Facility | | $27,928.04 | $36,273.58 | $43,569.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.15 / $1,486.34 / $6,502.69
| Professional | | $835.15 | $1,486.34 | $6,502.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $26,100.00 / $51,981.00
| Facility | | $3,340.00 | $26,100.00 | $51,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,575.00 / $4,622.39 / $7,233.61
| Professional | | $3,575.00 | $4,622.39 | $7,233.61 |