- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,570.00 / $10,836.00
| Facility | | $969.00 | $3,570.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,693.62 / $1,883.49 / $2,785.36
| Professional | | $1,693.62 | $1,883.49 | $2,785.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.04 / $2,089.81 / $2,911.58
| Professional | | $1,651.04 | $2,089.81 | $2,911.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.93 / $1,612.93 / $1,646.54
| Facility | | $1,612.93 | $1,612.93 | $1,646.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,055.25 / $4,619.00
| Facility | | $900.00 | $2,055.25 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.55 / $2,478.92 / $3,838.27
| Professional | | $1,761.55 | $2,478.92 | $3,838.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,382.96
| Facility | | $55.00 | $55.00 | $16,382.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,059.92 / $13,382.32 / $15,007.50
| Professional | | $13,059.92 | $13,382.32 | $15,007.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.30 / $2,222.48 / $3,864.90
| Facility | | $1,760.30 | $2,222.48 | $3,864.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,010.58 / $2,674.94 / $3,146.99
| Professional | | $2,010.58 | $2,674.94 | $3,146.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,921.80 / $3,367.85 / $6,652.33
| Professional | | $1,921.80 | $3,367.85 | $6,652.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.93 / $2,261.23 / $4,224.62
| Facility | | $1,764.93 | $2,261.23 | $4,224.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.08 / $2,579.50 / $4,506.60
| Professional | | $1,824.08 | $2,579.50 | $4,506.60 |
- 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
- $1,502.28 / $2,044.38 / $3,192.35
| Professional | | $1,502.28 | $2,044.38 | $3,192.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,492.15 / $1,744.90 / $2,357.17
| Professional | | $1,492.15 | $1,744.90 | $2,357.17 |