- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.77 / $4,990.00 / $10,437.62
| Facility | | $1,063.77 | $4,990.00 | $10,437.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.37 / $1,005.99 / $3,694.35
| Professional | | $863.37 | $1,005.99 | $3,694.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.57 / $1,045.58 / $1,850.51
| Professional | | $1,007.57 | $1,045.58 | $1,850.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.54 / $1,098.26 / $1,877.59
| Professional | | $838.54 | $1,098.26 | $1,877.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,206.08 / $1,550.68 / $1,604.88
| Professional | | $1,206.08 | $1,550.68 | $1,604.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,872.50 / $1,984.85 / $52,699.23
| Facility | | $1,872.50 | $1,984.85 | $52,699.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $5,526.00 / $11,182.00
| Facility | | $1,301.00 | $5,526.00 | $11,182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.53 / $1,069.38 / $5,325.71
| Professional | | $914.53 | $1,069.38 | $5,325.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.70 / $1,052.70 / $1,106.50
| Professional | | $1,052.70 | $1,052.70 | $1,106.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.90 / $1,137.90 / $1,137.90
| Facility | | $1,137.90 | $1,137.90 | $1,137.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.20 / $1,156.77 / $1,965.98
| Professional | | $883.20 | $1,156.77 | $1,965.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.34 / $982.77 / $982.77
| Facility | | $875.34 | $982.77 | $982.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.34 / $982.77 / $1,040.82
| Professional | | $875.34 | $982.77 | $1,040.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.00 / $3,879.00 / $7,508.00
| Facility | | $1,843.00 | $3,879.00 | $7,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.31 / $1,148.61 / $1,813.83
| Professional | | $869.31 | $1,148.61 | $1,813.83 |