- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.00 / $3,774.00 / $13,401.00
| Facility | | $1,082.00 | $3,774.00 | $13,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,697.06 / $2,027.37 / $3,272.06
| Professional | | $1,697.06 | $2,027.37 | $3,272.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,030.91 / $3,478.47 / $11,977.37
| Facility | | $2,030.91 | $3,478.47 | $11,977.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,907.57 / $2,361.84 / $3,312.82
| Professional | | $1,907.57 | $2,361.84 | $3,312.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,957.34 / $2,057.19
| Facility | | $80.00 | $1,957.34 | $2,057.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.37 / $2,368.37 / $2,368.37
| Facility | | $2,368.37 | $2,368.37 | $2,368.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,948.82 / $2,670.45 / $4,069.32
| Professional | | $1,948.82 | $2,670.45 | $4,069.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $25,623.07
| Facility | | $55.00 | $5,000.00 | $25,623.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,475.96 / $14,648.48 / $18,609.98
| Professional | | $14,475.96 | $14,648.48 | $18,609.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.16 / $2,366.77 / $3,953.02
| Facility | | $1,843.16 | $2,366.77 | $3,953.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,557.80 / $3,069.36 / $3,806.01
| Professional | | $2,557.80 | $3,069.36 | $3,806.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,045.64 / $2,797.56 / $3,802.87
| Professional | | $2,045.64 | $2,797.56 | $3,802.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.16 / $2,378.04 / $4,050.93
| Facility | | $1,843.16 | $2,378.04 | $4,050.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,981.70 / $2,731.58 / $4,157.07
| Professional | | $1,981.70 | $2,731.58 | $4,157.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,123.00 / $16,000.00
| Facility | | $2,600.00 | $7,123.00 | $16,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.45 / $2,155.98 / $3,448.07
| Professional | | $1,618.45 | $2,155.98 | $3,448.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,746.40 / $1,981.70 / $2,718.32
| Professional | | $1,746.40 | $1,981.70 | $2,718.32 |