- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $3,745.00 / $8,017.00
| Facility | | $1,068.00 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.88 / $1,076.65 / $1,448.02
| Professional | | $895.88 | $1,076.65 | $1,448.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.14 / $1,071.08 / $1,752.52
| Professional | | $1,032.14 | $1,071.08 | $1,752.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.00 / $549.00 / $549.00
| Facility | | $549.00 | $549.00 | $549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.44 / $1,022.41 / $1,749.70
| Professional | | $809.44 | $1,022.41 | $1,749.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.21 / $1,248.21 / $1,609.59
| Professional | | $1,248.21 | $1,248.21 | $1,609.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,964.00 / $8,017.00
| Facility | | $1,013.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.92 / $1,157.76 / $5,370.08
| Professional | | $975.92 | $1,157.76 | $5,370.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.20 / $944.20 / $944.20
| Professional | | $944.20 | $944.20 | $944.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.00 / $549.00 / $549.00
| Facility | | $549.00 | $549.00 | $549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.12 / $1,071.09 / $1,749.70
| Professional | | $815.12 | $1,071.09 | $1,749.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.33 / $1,022.76 / $1,022.76
| Facility | | $793.33 | $1,022.76 | $1,022.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.33 / $1,022.76 / $1,087.79
| Professional | | $793.33 | $1,022.76 | $1,087.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.00 / $3,311.00 / $6,000.00
| Facility | | $1,447.00 | $3,311.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.19 / $1,091.79 / $1,872.03
| Professional | | $822.19 | $1,091.79 | $1,872.03 |