- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.00 / $3,774.00 / $13,401.00
| Facility | | $1,082.00 | $3,774.00 | $13,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,846.53 / $2,216.87 / $3,592.50
| Professional | | $1,846.53 | $2,216.87 | $3,592.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,991.24 / $3,291.65 / $8,976.85
| Facility | | $1,991.24 | $3,291.65 | $8,976.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.50 / $2,657.46 / $3,583.07
| Professional | | $2,099.50 | $2,657.46 | $3,583.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,147.39 / $2,254.13
| Facility | | $80.00 | $2,147.39 | $2,254.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,586.94 / $2,586.94 / $2,586.94
| Facility | | $2,586.94 | $2,586.94 | $2,586.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,074.98 / $2,841.77 / $4,330.43
| Professional | | $2,074.98 | $2,841.77 | $4,330.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $22,939.11
| Facility | | $55.00 | $5,000.00 | $22,939.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,962.64 / $16,025.68 / $20,346.30
| Professional | | $15,962.64 | $16,025.68 | $20,346.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,024.15 / $2,543.08 / $4,257.79
| Facility | | $2,024.15 | $2,543.08 | $4,257.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,797.56 / $3,357.08 / $4,162.77
| Professional | | $2,797.56 | $3,357.08 | $4,162.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,024.15 / $2,574.86 / $4,361.92
| Facility | | $2,024.15 | $2,574.86 | $4,361.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,126.59 / $2,977.23 / $4,406.62
| Professional | | $2,126.59 | $2,977.23 | $4,406.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,123.00 / $16,000.00
| Facility | | $2,600.00 | $7,123.00 | $16,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.22 / $2,330.36 / $3,716.67
| Professional | | $1,752.22 | $2,330.36 | $3,716.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,910.11 / $2,166.80 / $2,973.93
| Professional | | $1,910.11 | $2,166.80 | $2,973.93 |