- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,244.36 / $10,964.78
| Facility | | $1,513.56 | $7,244.36 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $3,019.95
| Professional | | $1,000.00 | $1,148.15 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $1,995.26
| Professional | | $954.99 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,412.54 / $2,187.76
| Professional | | $977.24 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $1,698.24
| Professional | | $1,174.90 | $1,513.56 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,348.96 / $2,137.96
| Professional | | $1,023.29 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $26,915.35 / $33,884.42
| Facility | | $12,589.25 | $26,915.35 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,754.40 / $10,964.78
| Facility | | $1,288.25 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $3,548.13
| Professional | | $1,000.00 | $1,348.96 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $2,344.23
| Facility | | $1,445.44 | $1,445.44 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $2,398.83
| Professional | | $1,230.27 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $912.01 / $1,348.96
| Facility | | $467.74 | $912.01 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $912.01 / $1,122.02
| Professional | | $467.74 | $912.01 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,466.84 / $18,197.01
| Facility | | $2,344.23 | $4,466.84 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $2,187.76
| Professional | | $933.25 | $1,230.27 | $2,187.76 |