- 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
- $1,726.26 / $1,929.49 / $2,855.47
| Professional | | $1,726.26 | $1,929.49 | $2,855.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,715.89 / $2,092.53 / $2,909.78
| Professional | | $1,715.89 | $2,092.53 | $2,909.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.81 / $1,706.81 / $1,776.47
| Facility | | $1,706.81 | $1,706.81 | $1,776.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,142.85 / $4,619.00
| Facility | | $900.00 | $2,142.85 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.54 / $2,431.33 / $3,800.28
| Professional | | $1,609.54 | $2,431.33 | $3,800.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,900.40
| Facility | | $55.00 | $55.00 | $16,900.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,233.20 / $13,541.44 / $16,200.90
| Professional | | $13,233.20 | $13,541.44 | $16,200.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.51 / $2,141.60 / $3,812.68
| Facility | | $1,713.51 | $2,141.60 | $3,812.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,106.17 / $2,802.13 / $3,296.63
| Professional | | $2,106.17 | $2,802.13 | $3,296.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,354.10 / $4,723.50
| Professional | | $7.00 | $1,354.10 | $4,723.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.26 / $2,150.73 / $4,283.28
| Facility | | $1,726.26 | $2,150.73 | $4,283.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,784.67 / $2,605.17 / $4,677.05
| Professional | | $1,784.67 | $2,605.17 | $4,677.05 |
- 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
- $1,493.80 / $2,085.31 / $3,246.77
| Professional | | $1,493.80 | $2,085.31 | $3,246.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.10 / $1,815.95 / $2,449.14
| Professional | | $1,563.10 | $1,815.95 | $2,449.14 |