- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,075.00
| Facility | | $2,528.00 | $2,894.76 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.50 / $1,497.26 / $2,344.41
| Professional | | $1,148.50 | $1,497.26 | $2,344.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.78 / $4,751.20 / $11,879.05
| Facility | | $1,274.78 | $4,751.20 | $11,879.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.77 / $1,611.67 / $9,602.35
| Professional | | $979.77 | $1,611.67 | $9,602.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,681.23 / $2,225.67 / $2,957.13
| Professional | | $1,681.23 | $2,225.67 | $2,957.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.18 / $2,748.18 / $2,748.18
| Facility | | $2,748.18 | $2,748.18 | $2,748.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.44 / $2,006.08 / $3,702.29
| Professional | | $1,065.44 | $2,006.08 | $3,702.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.19 / $1,909.00 / $7,218.72
| Facility | | $1,125.19 | $1,909.00 | $7,218.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.33 / $1,547.34 / $2,135.94
| Professional | | $1,243.33 | $1,547.34 | $2,135.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.63 / $2,786.63 / $6,337.43
| Professional | | $1,383.63 | $2,786.63 | $6,337.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,994.70 / $2,035.69 / $5,301.97
| Facility | | $1,994.70 | $2,035.69 | $5,301.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.50 / $1,720.76 / $1,816.61
| Professional | | $1,651.50 | $1,720.76 | $1,816.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,063.00 / $12,850.00
| Facility | | $55.00 | $5,063.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.70 / $1,647.57 / $9,602.35
| Professional | | $1,153.70 | $1,647.57 | $9,602.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,063.00 / $10,764.00
| Facility | | $2,324.00 | $5,063.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.70 / $1,583.33 / $3,312.50
| Professional | | $1,153.70 | $1,583.33 | $3,312.50 |