- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.43 / $1,935.46 / $2,763.60
| Facility | | $1,459.43 | $1,935.46 | $2,763.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,649.24 / $2,105.73 / $3,394.46
| Professional | | $1,649.24 | $2,105.73 | $3,394.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.59 / $1,575.15 / $4,453.50
| Facility | | $891.59 | $1,575.15 | $4,453.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,883.17 / $2,346.40 / $3,237.63
| Professional | | $1,883.17 | $2,346.40 | $3,237.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,507.87 / $1,535.45
| Facility | | $80.00 | $1,507.87 | $1,535.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.24 / $3,013.24 / $3,013.24
| Facility | | $3,013.24 | $3,013.24 | $3,013.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,934.66 / $2,820.89 / $4,439.60
| Professional | | $1,934.66 | $2,820.89 | $4,439.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,663.57
| Facility | | $55.00 | $55.00 | $8,663.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,931.36 / $15,775.28 / $17,883.00
| Professional | | $12,931.36 | $15,775.28 | $17,883.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,785.26 / $2,772.25 / $4,165.54
| Facility | | $1,785.26 | $2,772.25 | $4,165.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,223.21 / $2,829.24 / $3,772.31
| Professional | | $2,223.21 | $2,829.24 | $3,772.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,048.80 / $3,048.80 / $3,048.80
| Professional | | $3,048.80 | $3,048.80 | $3,048.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.07 / $2,784.31 / $4,204.51
| Facility | | $1,786.07 | $2,784.31 | $4,204.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,952.73 / $2,969.16 / $4,485.78
| Professional | | $1,952.73 | $2,969.16 | $4,485.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,848.66 / $2,541.90 / $3,928.39
| Professional | | $1,848.66 | $2,541.90 | $3,928.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,788.64 / $2,039.28 / $2,836.70
| Professional | | $1,788.64 | $2,039.28 | $2,836.70 |