- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.00 / $3,416.40 / $9,574.50
| Facility | | $1,287.00 | $3,416.40 | $9,574.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.00 / $1,287.00 / $1,579.50
| Professional | | $1,092.00 | $1,287.00 | $1,579.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.00 / $1,950.00 / $1,950.00
| Professional | | $1,950.00 | $1,950.00 | $1,950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.50 / $4,189.39 / $7,819.50
| Facility | | $1,267.50 | $4,189.39 | $7,819.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.50 / $2,374.96 / $2,845.47
| Professional | | $1,033.50 | $2,374.96 | $2,845.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,120.00 / $9,262.50 / $9,262.50
| Facility | | $3,120.00 | $9,262.50 | $9,262.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,711.00 / $9,711.00 / $14,625.00
| Professional | | $9,711.00 | $9,711.00 | $14,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $1,950.00 / $2,731.23
| Facility | | $1,170.00 | $1,950.00 | $2,731.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,852.50 / $1,989.00 / $2,925.00
| Professional | | $1,852.50 | $1,989.00 | $2,925.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.50 / $2,437.50 / $6,825.00
| Professional | | $1,267.50 | $2,437.50 | $6,825.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.50 / $2,047.50 / $6,320.20
| Facility | | $1,228.50 | $2,047.50 | $6,320.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.00 / $2,437.50 / $3,412.50
| Professional | | $1,560.00 | $2,437.50 | $3,412.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.00 / $1,755.00 / $2,340.00
| Facility | | $819.00 | $1,755.00 | $2,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.10 / $819.00 / $1,170.00
| Professional | | $737.10 | $819.00 | $1,170.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.33 / $684.45 / $1,950.00
| Professional | | $325.33 | $684.45 | $1,950.00 |