- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,836.00
| Facility | | $969.00 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,701.45 / $1,892.22 / $2,636.57
| Professional | | $1,701.45 | $1,892.22 | $2,636.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.19 / $3,007.10 / $7,782.00
| Facility | | $1,806.19 | $3,007.10 | $7,782.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,439.14 / $1,914.06 / $2,869.24
| Professional | | $1,439.14 | $1,914.06 | $2,869.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,574.45 / $1,574.45 / $1,574.45
| Facility | | $1,574.45 | $1,574.45 | $1,574.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.96 / $2,421.94 / $3,663.50
| Professional | | $1,829.96 | $2,421.94 | $3,663.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $14,276.15
| Facility | | $55.00 | $55.00 | $14,276.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,038.40 / $13,333.20 / $14,857.35
| Professional | | $13,038.40 | $13,333.20 | $14,857.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $2,321.48 / $3,985.94
| Facility | | $1,770.00 | $2,321.48 | $3,985.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.78 / $2,659.11 / $3,128.36
| Professional | | $1,911.78 | $2,659.11 | $3,128.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,650.60 / $2,650.60 / $2,650.60
| Professional | | $2,650.60 | $2,650.60 | $2,650.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $2,321.48 / $4,257.50
| Facility | | $1,770.00 | $2,321.48 | $4,257.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.96 / $2,460.79 / $3,777.82
| Professional | | $1,829.96 | $2,460.79 | $3,777.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,502.77 / $2,077.58 / $3,328.63
| Professional | | $1,502.77 | $2,077.58 | $3,328.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.31 / $1,701.01 / $2,345.37
| Professional | | $1,483.31 | $1,701.01 | $2,345.37 |