- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.91 / $3,617.00 / $12,480.00
| Facility | | $1,055.91 | $3,617.00 | $12,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.64 / $1,286.98 / $2,017.62
| Professional | | $1,127.64 | $1,286.98 | $2,017.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.35 / $2,207.50 / $10,498.78
| Facility | | $1,269.35 | $2,207.50 | $10,498.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.18 / $1,482.43 / $2,020.07
| Professional | | $1,171.18 | $1,482.43 | $2,020.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,129.03 / $1,155.19
| Facility | | $80.00 | $1,129.03 | $1,155.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.74 / $1,440.74 / $1,440.74
| Facility | | $1,440.74 | $1,440.74 | $1,440.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,268.13 / $1,700.19 / $2,608.80
| Professional | | $1,268.13 | $1,700.19 | $2,608.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $10,169.95
| Facility | | $55.00 | $55.00 | $10,169.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,152.87 / $9,344.56 / $10,910.70
| Professional | | $9,152.87 | $9,344.56 | $10,910.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.30 / $1,601.23 / $2,445.19
| Facility | | $1,234.30 | $1,601.23 | $2,445.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.31 / $1,872.38 / $2,321.75
| Professional | | $1,560.31 | $1,872.38 | $2,321.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,430.51 / $2,199.36 / $4,727.37
| Professional | | $1,430.51 | $2,199.36 | $4,727.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.16 / $1,614.25 / $2,553.39
| Facility | | $1,236.16 | $1,614.25 | $2,553.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.17 / $1,769.30 / $2,664.00
| Professional | | $1,295.17 | $1,769.30 | $2,664.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,313.00 / $10,600.00
| Facility | | $1,634.00 | $4,313.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.59 / $1,335.59 / $2,142.81
| Professional | | $1,017.59 | $1,335.59 | $2,142.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.33 / $1,211.92 / $1,678.33
| Professional | | $1,065.33 | $1,211.92 | $1,678.33 |