- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.04 / $3,724.07 / $8,373.50
| Facility | | $1,603.04 | $3,724.07 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.50 / $1,884.50 / $2,261.06
| Professional | | $698.50 | $1,884.50 | $2,261.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,567.50 / $9,667.50 / $17,303.00
| Facility | | $7,567.50 | $9,667.50 | $17,303.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,563.78 / $10,216.95 / $13,180.78
| Facility | | $8,563.78 | $10,216.95 | $13,180.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,606.10 / $9,391.66 / $18,424.41
| Facility | | $4,606.10 | $9,391.66 | $18,424.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.90 / $100.00 / $5,509.60
| Facility | | $66.90 | $100.00 | $5,509.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.98 / $2,050.11 / $2,216.67
| Facility | | $1,921.98 | $2,050.11 | $2,216.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,422.76 / $2,411.82 / $3,308.74
| Professional | | $1,422.76 | $2,411.82 | $3,308.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.82 / $372.60 / $765.95
| Professional | | $260.82 | $372.60 | $765.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.32 / $932.14 / $932.14
| Professional | | $792.32 | $932.14 | $932.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.10 / $321.36 / $2,823.41
| Professional | | $278.10 | $321.36 | $2,823.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.88 / $1,901.58 / $2,777.55
| Professional | | $898.88 | $1,901.58 | $2,777.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,703.21 / $3,352.77 / $4,196.32
| Facility | | $2,703.21 | $3,352.77 | $4,196.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250.15 / $2,472.94 / $3,157.95
| Professional | | $2,250.15 | $2,472.94 | $3,157.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,068.00 / $9,520.00
| Facility | | $2,155.00 | $5,068.00 | $9,520.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.56 / $2,309.40 / $4,641.84
| Professional | | $732.56 | $2,309.40 | $4,641.84 |