- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.73 / $4,409.00 / $9,661.00
| Facility | | $1,129.73 | $4,409.00 | $9,661.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.12 / $1,116.08 / $2,452.98
| Professional | | $809.12 | $1,116.08 | $2,452.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.92 / $1,506.57 / $2,888.72
| Professional | | $1,142.92 | $1,506.57 | $2,888.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.00 / $1,266.00 / $8,917.50
| Facility | | $1,266.00 | $1,266.00 | $8,917.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.00 / $1,266.00 / $1,266.00
| Professional | | $1,266.00 | $1,266.00 | $1,266.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.33 / $1,039.33 / $7,227.90
| Facility | | $1,039.33 | $1,039.33 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.92 / $1,844.49 / $4,134.04
| Professional | | $980.92 | $1,844.49 | $4,134.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,513.17 / $2,640.00
| Facility | | $319.00 | $1,513.17 | $2,640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.00 / $1,850.00 / $4,667.34
| Professional | | $1,035.00 | $1,850.00 | $4,667.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.24 / $953.37 / $1,660.10
| Professional | | $727.24 | $953.37 | $1,660.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $1,039.33 / $7,227.90
| Facility | | $555.00 | $1,039.33 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.07 / $1,768.30 / $3,688.80
| Professional | | $1,094.07 | $1,768.30 | $3,688.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,031.00 / $4,840.00 / $9,202.00
| Facility | | $2,031.00 | $4,840.00 | $9,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.83 / $1,448.74 / $2,811.94
| Professional | | $896.83 | $1,448.74 | $2,811.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.31 / $966.31 / $3,108.17
| Facility | | $966.31 | $966.31 | $3,108.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.53 / $966.31 / $1,877.22
| Professional | | $812.53 | $966.31 | $1,877.22 |