- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.00 / $3,219.00 / $11,453.00
| Facility | | $880.00 | $3,219.00 | $11,453.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.35 / $1,071.56 / $1,666.20
| Professional | | $945.35 | $1,071.56 | $1,666.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,017.43 / $3,640.66 / $7,861.04
| Facility | | $2,017.43 | $3,640.66 | $7,861.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.15 / $1,198.71 / $1,681.36
| Professional | | $968.15 | $1,198.71 | $1,681.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $949.14 / $965.56
| Facility | | $80.00 | $949.14 | $965.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.05 / $1,197.05 / $1,197.05
| Facility | | $1,197.05 | $1,197.05 | $1,197.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,048.52 / $1,400.61 / $2,185.03
| Professional | | $1,048.52 | $1,400.61 | $2,185.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $6,817.20
| Facility | | $55.00 | $55.00 | $6,817.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,644.24 / $7,750.00 / $9,089.40
| Professional | | $7,644.24 | $7,750.00 | $9,089.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.72 / $1,262.75 / $2,121.42
| Facility | | $979.72 | $1,262.75 | $2,121.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.14 / $1,561.37 / $1,936.09
| Professional | | $1,301.14 | $1,561.37 | $1,936.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.19 / $1,744.20 / $3,795.59
| Professional | | $1,062.19 | $1,744.20 | $3,795.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.92 / $1,287.77 / $2,216.63
| Facility | | $989.92 | $1,287.77 | $2,216.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.18 / $1,445.08 / $2,212.23
| Professional | | $1,073.18 | $1,445.08 | $2,212.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,326.00 / $7,600.00
| Facility | | $1,154.00 | $3,326.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.61 / $1,145.45 / $1,815.04
| Professional | | $860.61 | $1,145.45 | $1,815.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.39 / $1,008.96 / $1,400.96
| Professional | | $888.39 | $1,008.96 | $1,400.96 |