- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.00 / $3,682.00 / $12,826.00
| Facility | | $1,002.00 | $3,682.00 | $12,826.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.58 / $1,414.75 / $2,350.34
| Professional | | $1,239.58 | $1,414.75 | $2,350.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.44 / $1,624.29 / $2,220.21
| Professional | | $1,278.44 | $1,624.29 | $2,220.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,237.30 / $1,266.85
| Facility | | $80.00 | $1,237.30 | $1,266.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.46 / $1,584.46 / $1,584.46
| Facility | | $1,584.46 | $1,584.46 | $1,584.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,349.94 / $1,865.35 / $2,807.58
| Professional | | $1,349.94 | $1,865.35 | $2,807.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,179.00
| Facility | | $55.00 | $55.00 | $11,179.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,697.50 / $10,697.50 / $11,999.03
| Professional | | $10,697.50 | $10,697.50 | $11,999.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.55 / $1,688.79 / $2,881.19
| Facility | | $1,349.55 | $1,688.79 | $2,881.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,715.58 / $2,058.69 / $2,552.78
| Professional | | $1,715.58 | $2,058.69 | $2,552.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.16 / $1,589.69 / $1,808.80
| Professional | | $1,466.16 | $1,589.69 | $1,808.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.38 / $1,694.61 / $2,945.00
| Facility | | $1,347.38 | $1,694.61 | $2,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.80 / $1,940.50 / $2,921.05
| Professional | | $1,415.80 | $1,940.50 | $2,921.05 |
- 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
- $1,103.67 / $1,517.55 / $2,363.05
| Professional | | $1,103.67 | $1,517.55 | $2,363.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.34 / $1,332.87 / $1,845.00
| Professional | | $1,171.34 | $1,332.87 | $1,845.00 |