- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.00 / $3,596.00 / $10,836.00
| Facility | | $921.00 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.39 / $1,091.35 / $1,742.42
| Professional | | $915.39 | $1,091.35 | $1,742.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.33 / $1,999.74 / $9,631.00
| Facility | | $1,180.33 | $1,999.74 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.25 / $1,425.16 / $1,985.56
| Professional | | $1,118.25 | $1,425.16 | $1,985.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.27 / $1,145.27 / $1,145.27
| Facility | | $1,145.27 | $1,145.27 | $1,145.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.30 / $1,612.10 / $2,461.36
| Professional | | $1,249.30 | $1,612.10 | $2,461.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,897.00 / $19,388.59
| Facility | | $55.00 | $5,897.00 | $19,388.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,672.40 / $8,869.76 / $10,569.98
| Professional | | $8,672.40 | $8,869.76 | $10,569.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.66 / $1,421.99 / $2,649.18
| Facility | | $1,118.66 | $1,421.99 | $2,649.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.50 / $1,831.13 / $2,154.28
| Professional | | $1,316.50 | $1,831.13 | $2,154.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.60 / $1,659.82 / $2,666.41
| Professional | | $1,161.60 | $1,659.82 | $2,666.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.66 / $1,484.68 / $2,716.84
| Facility | | $1,118.66 | $1,484.68 | $2,716.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.30 / $1,634.25 / $2,536.46
| Professional | | $1,249.30 | $1,634.25 | $2,536.46 |
- 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
- $949.79 / $1,300.72 / $2,055.33
| Professional | | $949.79 | $1,300.72 | $2,055.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.45 / $1,161.60 / $1,604.02
| Professional | | $1,021.45 | $1,161.60 | $1,604.02 |