- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $4,048.00 / $8,451.00
| Facility | | $1,257.44 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.43 / $1,171.80 / $1,371.12
| Professional | | $849.43 | $1,171.80 | $1,371.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,896.00 / $16,397.00 / $24,338.00
| Facility | | $13,896.00 | $16,397.00 | $24,338.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,495.62 / $1,495.62 / $1,495.62
| Facility | | $1,495.62 | $1,495.62 | $1,495.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.44 / $1,578.20 / $2,605.39
| Professional | | $1,053.44 | $1,578.20 | $2,605.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,921.98 / $2,778.53 / $3,319.78
| Professional | | $1,921.98 | $2,778.53 | $3,319.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,068.95 / $11,210.28 / $27,853.01
| Facility | | $4,068.95 | $11,210.28 | $27,853.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.95 / $1,333.42 / $1,598.36
| Professional | | $1,291.95 | $1,333.42 | $1,598.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $4,993.00 / $10,247.00
| Facility | | $1,151.00 | $4,993.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.53 / $1,257.44 / $3,093.30
| Professional | | $916.53 | $1,257.44 | $3,093.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $8.00 / $8.00
| Professional | | $8.00 | $8.00 | $8.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,495.62 / $1,495.62 / $1,495.62
| Facility | | $1,495.62 | $1,495.62 | $1,495.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.85 / $1,595.56 / $2,605.39
| Professional | | $1,110.85 | $1,595.56 | $2,605.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,487.71 / $1,487.71 / $1,487.71
| Professional | | $1,487.71 | $1,487.71 | $1,487.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $4,563.00 / $9,631.00
| Facility | | $2,468.00 | $4,563.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.98 / $1,418.66 / $2,310.19
| Professional | | $855.98 | $1,418.66 | $2,310.19 |