- 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
- $1,829.00 / $2,047.40 / $3,025.07
| Professional | | $1,829.00 | $2,047.40 | $3,025.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.64 / $2,319.67 / $3,231.83
| Professional | | $1,832.64 | $2,319.67 | $3,231.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,810.35 / $1,810.35 / $1,883.65
| Facility | | $1,810.35 | $1,810.35 | $1,883.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,270.62 / $4,619.00
| Facility | | $900.00 | $2,270.62 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,899.45 / $2,597.85 / $4,095.38
| Professional | | $1,899.45 | $2,597.85 | $4,095.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $17,907.36
| Facility | | $55.00 | $55.00 | $17,907.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,020.96 / $14,354.56 / $17,165.48
| Professional | | $14,020.96 | $14,354.56 | $17,165.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,893.49 / $2,337.62 / $4,115.52
| Facility | | $1,893.49 | $2,337.62 | $4,115.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,231.54 / $2,968.92 / $3,492.85
| Professional | | $2,231.54 | $2,968.92 | $3,492.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,873.70 / $3,583.87 / $7,241.27
| Professional | | $1,873.70 | $3,583.87 | $7,241.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,894.89 / $2,365.91 / $4,543.70
| Facility | | $1,894.89 | $2,365.91 | $4,543.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,974.41 / $2,775.86 / $4,957.59
| Professional | | $1,974.41 | $2,775.86 | $4,957.59 |
- 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
- $1,594.25 / $2,182.08 / $3,443.24
| Professional | | $1,594.25 | $2,182.08 | $3,443.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.13 / $1,924.06 / $2,595.04
| Professional | | $1,656.13 | $1,924.06 | $2,595.04 |