- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.00 / $3,928.28 / $10,649.00
| Facility | | $1,093.00 | $3,928.28 | $10,649.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,890.08 / $3,247.79 / $4,698.31
| Professional | | $2,890.08 | $3,247.79 | $4,698.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,875.11 / $3,652.90 / $4,993.12
| Professional | | $2,875.11 | $3,652.90 | $4,993.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,879.66 / $2,879.66 / $2,994.42
| Facility | | $2,879.66 | $2,879.66 | $2,994.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,619.00
| Facility | | $900.00 | $2,277.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,067.74 / $4,215.96 / $6,610.69
| Professional | | $3,067.74 | $4,215.96 | $6,610.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,800.00 / $56,578.56
| Facility | | $55.00 | $2,800.00 | $56,578.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,171.76 / $22,633.12 / $27,083.33
| Professional | | $22,171.76 | $22,633.12 | $27,083.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,979.40 / $3,437.25 / $6,951.90
| Facility | | $2,979.40 | $3,437.25 | $6,951.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,524.92 / $4,689.68 / $5,517.27
| Professional | | $3,524.92 | $4,689.68 | $5,517.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,865.37 / $3,353.94 / $5,986.78
| Professional | | $2,865.37 | $3,353.94 | $5,986.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,979.40 / $3,478.94 / $7,115.86
| Facility | | $2,979.40 | $3,478.94 | $7,115.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,195.20 / $4,430.70 / $7,876.69
| Professional | | $3,195.20 | $4,430.70 | $7,876.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $2,546.00 / $9,000.00
| Facility | | $471.00 | $2,546.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,634.54 / $3,564.38 / $5,662.21
| Professional | | $2,634.54 | $3,564.38 | $5,662.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,616.01 / $3,039.67 / $4,098.87
| Professional | | $2,616.01 | $3,039.67 | $4,098.87 |