- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.05 / $3,996.00 / $10,296.00
| Facility | | $1,387.05 | $3,996.00 | $10,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.09 / $1,403.41 / $2,205.40
| Professional | | $905.09 | $1,403.41 | $2,205.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,283.00 / $5,221.66 / $11,909.00
| Facility | | $3,283.00 | $5,221.66 | $11,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.17 / $1,230.29 / $2,776.93
| Professional | | $941.17 | $1,230.29 | $2,776.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,625.30 / $1,625.30 / $37,499.62
| Facility | | $1,625.30 | $1,625.30 | $37,499.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.30 / $1,625.30 / $1,625.30
| Professional | | $1,625.30 | $1,625.30 | $1,625.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.88 / $1,308.88 / $7,227.90
| Facility | | $1,308.88 | $1,308.88 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.28 / $2,040.63 / $4,486.82
| Professional | | $995.28 | $2,040.63 | $4,486.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,860.00 / $2,976.00
| Facility | | $319.00 | $1,860.00 | $2,976.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.97 / $1,559.87 / $2,334.42
| Professional | | $1,304.97 | $1,559.87 | $2,334.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.92 / $1,398.50 / $2,079.41
| Professional | | $895.92 | $1,398.50 | $2,079.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $1,308.88 / $7,227.90
| Facility | | $555.00 | $1,308.88 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.31 / $1,944.41 / $4,156.96
| Professional | | $1,184.31 | $1,944.41 | $4,156.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $4,194.00 / $9,300.00
| Facility | | $1,749.00 | $4,194.00 | $9,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.66 / $1,452.29 / $3,601.28
| Professional | | $1,008.66 | $1,452.29 | $3,601.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.29 / $1,485.29 / $3,995.32
| Facility | | $1,485.29 | $1,485.29 | $3,995.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.92 / $1,485.29 / $2,426.01
| Professional | | $895.92 | $1,485.29 | $2,426.01 |