- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.00 / $3,102.00 / $10,836.00
| Facility | | $803.00 | $3,102.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.68 / $1,173.35 / $1,781.31
| Professional | | $794.68 | $1,173.35 | $1,781.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,710.30 / $4,733.89 / $9,486.04
| Facility | | $2,710.30 | $4,733.89 | $9,486.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.50 / $1,322.69 / $2,269.60
| Professional | | $831.50 | $1,322.69 | $2,269.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.29 / $766.29 / $1,394.48
| Facility | | $766.29 | $766.29 | $1,394.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.44 / $1,447.32 / $2,307.21
| Professional | | $931.44 | $1,447.32 | $2,307.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $6,265.68
| Facility | | $55.00 | $55.00 | $6,265.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,648.72 / $10,124.95 / $11,737.28
| Professional | | $6,648.72 | $10,124.95 | $11,737.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.17 / $1,218.40 / $1,810.85
| Facility | | $860.17 | $1,218.40 | $1,810.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.89 / $1,699.00 / $2,528.11
| Professional | | $1,109.89 | $1,699.00 | $2,528.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.68 / $1,399.08 / $1,787.49
| Professional | | $852.68 | $1,399.08 | $1,787.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.27 / $1,218.40 / $1,813.63
| Facility | | $857.27 | $1,218.40 | $1,813.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.96 / $1,526.99 / $2,498.71
| Professional | | $967.96 | $1,526.99 | $2,498.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,194.47 / $1,573.47 / $2,388.96
| Professional | | $1,194.47 | $1,573.47 | $2,388.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.04 / $1,307.92 / $1,831.09
| Professional | | $1,160.04 | $1,307.92 | $1,831.09 |