- 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
- $1,499.79 / $1,674.90 / $2,550.02
| Professional | | $1,499.79 | $1,674.90 | $2,550.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.22 / $1,899.40 / $2,645.61
| Professional | | $1,500.22 | $1,899.40 | $2,645.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.01 / $1,487.01 / $1,545.71
| Facility | | $1,487.01 | $1,487.01 | $1,545.71 |
- 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
- $1,555.26 / $2,159.56 / $3,334.17
| Professional | | $1,555.26 | $2,159.56 | $3,334.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,523.00
| Facility | | $55.00 | $55.00 | $16,523.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,499.68 / $11,765.92 / $14,073.00
| Professional | | $11,499.68 | $11,765.92 | $14,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.94 / $1,915.97 / $3,324.86
| Facility | | $1,549.94 | $1,915.97 | $3,324.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.79 / $2,434.41 / $2,864.02
| Professional | | $1,829.79 | $2,434.41 | $2,864.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.30 / $2,943.19 / $5,954.29
| Professional | | $1,684.30 | $2,943.19 | $5,954.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.94 / $1,937.73 / $3,713.17
| Facility | | $1,549.94 | $1,937.73 | $3,713.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,612.92 / $2,268.85 / $4,063.68
| Professional | | $1,612.92 | $2,268.85 | $4,063.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $2,502.00 / $9,000.00
| Facility | | $471.00 | $2,502.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.65 / $1,791.27 / $2,814.19
| Professional | | $1,319.65 | $1,791.27 | $2,814.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.97 / $1,577.78 / $2,128.21
| Professional | | $1,357.97 | $1,577.78 | $2,128.21 |