- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $10,836.00
| Facility | | $969.00 | $3,682.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,574.90 / $1,782.57 / $2,612.34
| Professional | | $1,574.90 | $1,782.57 | $2,612.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.84 / $2,794.81 / $12,542.13
| Facility | | $1,674.84 | $2,794.81 | $12,542.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,690.75 / $2,148.31 / $2,981.60
| Professional | | $1,690.75 | $2,148.31 | $2,981.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.56 / $1,593.56 / $1,593.56
| Facility | | $1,593.56 | $1,593.56 | $1,593.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.51 / $2,424.88 / $3,720.50
| Professional | | $1,815.51 | $2,424.88 | $3,720.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $18,388.98
| Facility | | $55.00 | $55.00 | $18,388.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,714.40 / $13,112.00 / $15,920.33
| Professional | | $12,714.40 | $13,112.00 | $15,920.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,733.10 / $2,269.28 / $3,657.40
| Facility | | $1,733.10 | $2,269.28 | $3,657.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,959.10 / $2,724.93 / $3,205.80
| Professional | | $1,959.10 | $2,724.93 | $3,205.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,355.30 / $2,355.30 / $2,355.30
| Professional | | $2,355.30 | $2,355.30 | $2,355.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,733.10 / $2,286.91 / $3,743.66
| Facility | | $1,733.10 | $2,286.91 | $3,743.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.51 / $2,505.52 / $3,775.61
| Professional | | $1,815.51 | $2,505.52 | $3,775.61 |
- 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
- $1,455.65 / $2,043.94 / $3,152.08
| Professional | | $1,455.65 | $2,043.94 | $3,152.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,520.03 / $1,733.10 / $2,374.87
| Professional | | $1,520.03 | $1,733.10 | $2,374.87 |