- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,049.35 / $4,361.26 / $10,296.00
| Facility | | $2,049.35 | $4,361.26 | $10,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,071.38 / $2,583.15 / $4,670.76
| Professional | | $2,071.38 | $2,583.15 | $4,670.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $9,750.00 / $16,411.00
| Facility | | $4,989.00 | $9,750.00 | $16,411.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,604.31 / $2,097.14 / $4,568.56
| Professional | | $1,604.31 | $2,097.14 | $4,568.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,716.87 / $2,716.87 / $37,499.62
| Facility | | $2,716.87 | $2,716.87 | $37,499.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,716.87 / $2,716.87 / $2,716.87
| Professional | | $2,716.87 | $2,716.87 | $2,716.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,198.23 / $2,198.23 / $7,227.90
| Facility | | $2,198.23 | $2,198.23 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,888.58 / $3,168.78 / $7,030.27
| Professional | | $1,888.58 | $3,168.78 | $7,030.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $3,485.00 / $15,947.68
| Facility | | $332.00 | $3,485.00 | $15,947.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,050.19 / $2,733.59 / $3,940.92
| Professional | | $2,050.19 | $2,733.59 | $3,940.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.72 / $1,838.05 / $3,282.20
| Professional | | $1,303.72 | $1,838.05 | $3,282.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $2,198.23 / $74,999.25
| Facility | | $555.00 | $2,198.23 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.30 / $3,284.45 / $7,030.27
| Professional | | $1,975.30 | $3,284.45 | $7,030.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $4,194.00 / $9,300.00
| Facility | | $1,749.00 | $4,194.00 | $9,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.89 / $2,497.81 / $6,136.05
| Professional | | $1,915.89 | $2,497.81 | $6,136.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,407.40 / $2,407.40 / $7,183.01
| Facility | | $2,407.40 | $2,407.40 | $7,183.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.72 / $2,746.51 / $4,810.10
| Professional | | $1,303.72 | $2,746.51 | $4,810.10 |