- 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
- $1,644.26 / $1,836.56 / $2,783.32
| Professional | | $1,644.26 | $1,836.56 | $2,783.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.50 / $2,083.34 / $2,901.81
| Professional | | $1,645.50 | $2,083.34 | $2,901.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,626.46 / $1,626.46 / $1,692.58
| Facility | | $1,626.46 | $1,626.46 | $1,692.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,040.31 / $4,619.00
| Facility | | $900.00 | $2,040.31 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.26 / $2,339.40 / $3,669.97
| Professional | | $1,700.26 | $2,339.40 | $3,669.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,098.16
| Facility | | $55.00 | $55.00 | $16,098.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,604.96 / $12,896.08 / $15,430.88
| Professional | | $12,604.96 | $12,896.08 | $15,430.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.40 / $2,088.55 / $3,823.50
| Facility | | $1,695.40 | $2,088.55 | $3,823.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,006.12 / $2,669.01 / $3,140.01
| Professional | | $2,006.12 | $2,669.01 | $3,140.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $2,085.90 / $4,496.50
| Professional | | $7.00 | $2,085.90 | $4,496.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.25 / $2,124.75 / $4,076.04
| Facility | | $1,698.25 | $2,124.75 | $4,076.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,749.04 / $2,490.69 / $4,479.10
| Professional | | $1,749.04 | $2,490.69 | $4,479.10 |
- 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
- $1,455.03 / $1,984.13 / $3,089.77
| Professional | | $1,455.03 | $1,984.13 | $3,089.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.84 / $1,729.70 / $2,332.85
| Professional | | $1,488.84 | $1,729.70 | $2,332.85 |