- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,570.00 / $10,893.00
| Facility | | $945.00 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.54 / $1,564.50 / $2,319.17
| Professional | | $1,402.54 | $1,564.50 | $2,319.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.62 / $1,775.02 / $2,473.00
| Professional | | $1,368.62 | $1,775.02 | $2,473.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.62 / $1,389.62 / $1,444.76
| Facility | | $1,389.62 | $1,389.62 | $1,444.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,024.00 / $4,619.00
| Facility | | $900.00 | $2,024.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.16 / $1,981.39 / $3,123.87
| Professional | | $1,432.16 | $1,981.39 | $3,123.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $13,734.24
| Facility | | $55.00 | $55.00 | $13,734.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,754.00 / $11,001.04 / $13,160.03
| Professional | | $10,754.00 | $11,001.04 | $13,160.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.23 / $1,763.06 / $3,106.40
| Facility | | $1,447.23 | $1,763.06 | $3,106.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,711.13 / $2,276.55 / $2,678.29
| Professional | | $1,711.13 | $2,276.55 | $2,678.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,599.20 / $3,833.00
| Professional | | $7.00 | $1,599.20 | $3,833.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.23 / $1,796.43 / $3,467.59
| Facility | | $1,447.23 | $1,796.43 | $3,467.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.00 / $2,117.59 / $3,798.91
| Professional | | $1,467.00 | $2,117.59 | $3,798.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,219.05 / $1,675.93 / $2,626.54
| Professional | | $1,219.05 | $1,675.93 | $2,626.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.91 / $1,475.46 / $1,990.14
| Professional | | $1,269.91 | $1,475.46 | $1,990.14 |