- 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
- $1,341.95 / $1,528.43 / $2,179.02
| Professional | | $1,341.95 | $1,528.43 | $2,179.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.73 / $2,514.08 / $6,520.90
| Facility | | $1,492.73 | $2,514.08 | $6,520.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.18 / $1,784.20 / $2,476.25
| Professional | | $1,404.18 | $1,784.20 | $2,476.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.00 / $1,399.00 / $1,399.00
| Facility | | $1,399.00 | $1,399.00 | $1,399.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.80 / $2,041.88 / $3,098.85
| Professional | | $1,530.80 | $2,041.88 | $3,098.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $13,938.80
| Facility | | $55.00 | $55.00 | $13,938.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,036.96 / $11,348.40 / $12,934.95
| Professional | | $11,036.96 | $11,348.40 | $12,934.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,460.75 / $1,921.99 / $3,424.37
| Facility | | $1,460.75 | $1,921.99 | $3,424.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.35 / $2,282.96 / $2,685.85
| Professional | | $1,641.35 | $2,282.96 | $2,685.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.69 / $2,049.69 / $2,049.69
| Professional | | $2,049.69 | $2,049.69 | $2,049.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,475.05 / $1,921.99 / $3,573.36
| Facility | | $1,475.05 | $1,921.99 | $3,573.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.80 / $2,071.78 / $3,339.02
| Professional | | $1,530.80 | $2,071.78 | $3,339.02 |
- 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
- $1,211.45 / $1,690.25 / $2,628.85
| Professional | | $1,211.45 | $1,690.25 | $2,628.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,273.50 / $1,452.68 / $2,009.26
| Professional | | $1,273.50 | $1,452.68 | $2,009.26 |