- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,715.35 / $12,882.50
| Facility | | $1,000.00 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,041.74 / $3,162.28
| Professional | | $1,778.28 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,778.28 / $1,995.26
| Professional | | $1,737.80 | $1,778.28 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,511.89 / $3,981.07
| Professional | | $1,905.46 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $19,498.45
| Facility | | $54.95 | $56.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $24,547.09
| Professional | | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,511.89 / $5,128.61
| Facility | | $1,659.59 | $2,511.89 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,290.87 / $3,019.95
| Professional | | $1,819.70 | $2,290.87 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $251.19
| Professional | | $32.36 | $33.11 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $3,548.13 / $4,677.35
| Professional | | $7.94 | $3,548.13 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,511.89 / $4,365.16
| Facility | | $1,778.28 | $2,511.89 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $3,890.45
| Professional | | $1,862.09 | $2,511.89 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,454.71 / $10,232.93
| Facility | | $436.52 | $2,454.71 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,137.96 / $3,388.44
| Professional | | $1,584.89 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,737.80 / $1,737.80
| Professional | | $1,621.81 | $1,737.80 | $1,737.80 |