- 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
- $1,191.17 / $1,384.99 / $2,153.81
| Professional | | $1,191.17 | $1,384.99 | $2,153.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.26 / $2,400.00 / $6,183.91
| Facility | | $1,447.26 | $2,400.00 | $6,183.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.85 / $1,675.67 / $2,334.58
| Professional | | $1,323.85 | $1,675.67 | $2,334.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.29 / $1,515.29 / $1,515.29
| Facility | | $1,515.29 | $1,515.29 | $1,515.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.06 / $1,972.68 / $2,918.42
| Professional | | $1,517.06 | $1,972.68 | $2,918.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $19,394.16
| Facility | | $55.00 | $55.00 | $19,394.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,192.37 / $16,192.37 / $16,192.37
| Professional | | $16,192.37 | $16,192.37 | $16,192.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.47 / $1,860.50 / $3,381.02
| Facility | | $1,360.47 | $1,860.50 | $3,381.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,540.31 / $2,142.42 / $2,520.50
| Professional | | $1,540.31 | $2,142.42 | $2,520.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,970.90 / $1,970.90 / $1,970.90
| Professional | | $1,970.90 | $1,970.90 | $1,970.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.47 / $1,895.40 / $3,691.55
| Facility | | $1,360.47 | $1,895.40 | $3,691.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.06 / $1,991.58 / $3,025.26
| Professional | | $1,517.06 | $1,991.58 | $3,025.26 |
- 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
- $1,173.06 / $1,612.95 / $2,492.73
| Professional | | $1,173.06 | $1,612.95 | $2,492.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.09 / $1,360.47 / $1,873.81
| Professional | | $1,195.09 | $1,360.47 | $1,873.81 |