- 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
- $1,242.76 / $1,507.18 / $2,094.78
| Professional | | $1,242.76 | $1,507.18 | $2,094.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.09 / $2,334.17 / $7,269.63
| Facility | | $1,415.09 | $2,334.17 | $7,269.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.08 / $2,092.16 / $2,462.23
| Professional | | $1,829.08 | $2,092.16 | $2,462.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.89 / $1,292.89 / $1,292.89
| Facility | | $1,292.89 | $1,292.89 | $1,292.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,390.30 / $1,856.71 / $2,846.45
| Professional | | $1,390.30 | $1,856.71 | $2,846.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $29,406.30
| Facility | | $55.00 | $55.00 | $29,406.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,710.95 / $9,955.84 / $11,842.58
| Professional | | $9,710.95 | $9,955.84 | $11,842.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,332.78 / $1,817.39 / $3,092.78
| Facility | | $1,332.78 | $1,817.39 | $3,092.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.55 / $2,052.36 / $2,414.54
| Professional | | $1,475.55 | $2,052.36 | $2,414.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,278.60 / $2,278.60 / $2,278.60
| Professional | | $2,278.60 | $2,278.60 | $2,278.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,332.78 / $1,857.46 / $3,526.03
| Facility | | $1,332.78 | $1,857.46 | $3,526.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.98 / $1,904.36 / $2,916.02
| Professional | | $1,413.98 | $1,904.36 | $2,916.02 |
- 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
- $1,142.18 / $1,577.17 / $2,477.41
| Professional | | $1,142.18 | $1,577.17 | $2,477.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.84 / $1,309.24 / $1,793.76
| Professional | | $1,144.84 | $1,309.24 | $1,793.76 |