- 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
- $1,474.98 / $1,660.83 / $2,340.40
| Professional | | $1,474.98 | $1,660.83 | $2,340.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.66 / $2,800.07 / $8,923.45
| Facility | | $1,637.66 | $2,800.07 | $8,923.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.67 / $1,876.70 / $2,613.89
| Professional | | $1,482.67 | $1,876.70 | $2,613.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.37 / $1,471.37 / $1,471.37
| Facility | | $1,471.37 | $1,471.37 | $1,471.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.86 / $2,220.94 / $3,412.85
| Professional | | $1,723.86 | $2,220.94 | $3,412.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $19,785.70
| Facility | | $55.00 | $55.00 | $19,785.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,288.48 / $11,601.44 / $13,826.40
| Professional | | $11,288.48 | $11,601.44 | $13,826.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.62 / $2,034.32 / $3,664.29
| Facility | | $1,545.62 | $2,034.32 | $3,664.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,719.99 / $2,392.35 / $2,814.53
| Professional | | $1,719.99 | $2,392.35 | $2,814.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.84 / $2,131.77 / $3,336.68
| Professional | | $1,709.84 | $2,131.77 | $3,336.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.50 / $2,051.25 / $3,750.71
| Facility | | $1,549.50 | $2,051.25 | $3,750.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.86 / $2,287.88 / $3,678.68
| Professional | | $1,723.86 | $2,287.88 | $3,678.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,547.00 / $9,000.00
| Facility | | $495.00 | $2,547.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,399.35 / $1,914.26 / $2,958.41
| Professional | | $1,399.35 | $1,914.26 | $2,958.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.51 / $1,531.69 / $2,086.59
| Professional | | $1,334.51 | $1,531.69 | $2,086.59 |