- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.41 / $2,747.00 / $5,455.51
| Facility | | $849.41 | $2,747.00 | $5,455.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.61 / $940.66 / $2,504.83
| Professional | | $797.61 | $940.66 | $2,504.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $5,063.00 / $26,542.00
| Facility | | $1,591.00 | $5,063.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.50 / $1,838.41 / $9,862.15
| Professional | | $963.50 | $1,838.41 | $9,862.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.42 / $1,097.20 / $2,501.62
| Professional | | $422.42 | $1,097.20 | $2,501.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,051.59 / $6,493.89
| Facility | | $956.00 | $1,051.59 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.98 / $1,486.61 / $2,900.66
| Professional | | $710.98 | $1,486.61 | $2,900.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $1,909.00 / $6,679.00
| Facility | | $814.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.17 / $1,350.42 / $1,969.76
| Professional | | $1,061.17 | $1,350.42 | $1,969.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.52 / $2,267.17 / $2,927.58
| Professional | | $1,148.52 | $2,267.17 | $2,927.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,769.92 / $3,769.92 / $5,593.58
| Facility | | $3,769.92 | $3,769.92 | $5,593.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,697.78 / $2,697.78 / $2,697.78
| Professional | | $2,697.78 | $2,697.78 | $2,697.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $6,204.00 / $26,542.00
| Facility | | $1,591.00 | $6,204.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.34 / $1,862.01 / $9,862.15
| Professional | | $1,021.34 | $1,862.01 | $9,862.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.80 / $1,440.52 / $2,991.01
| Professional | | $983.80 | $1,440.52 | $2,991.01 |