- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,715.35 / $13,489.63
| Facility | | $1,000.00 | $3,715.35 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,238.72 / $3,388.44
| Professional | | $1,819.70 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,344.23 / $3,890.45
| Professional | | $1,698.24 | $2,344.23 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $4,466.84
| Professional | | $2,137.96 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $28,840.32
| Facility | | $54.95 | $56.23 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $19,498.45 / $19,498.45
| Professional | | $16,982.44 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,818.38 / $5,623.41
| Facility | | $1,862.09 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,691.53 / $3,715.35
| Professional | | $1,905.46 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $295.12
| Professional | | $32.36 | $33.11 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $4,168.69 / $5,370.32
| Professional | | $10.96 | $4,168.69 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,691.53 / $5,011.87
| Facility | | $2,041.74 | $2,691.53 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,884.03 / $4,365.16
| Professional | | $2,089.30 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,454.71 / $10,232.93
| Facility | | $436.52 | $2,454.71 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,398.83 / $3,715.35
| Professional | | $1,737.80 | $2,398.83 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,238.72 / $2,238.72
| Professional | | $1,995.26 | $2,238.72 | $2,238.72 |