- 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
- $910.90 / $1,093.42 / $1,506.75
| Professional | | $910.90 | $1,093.42 | $1,506.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.98 / $1,735.75 / $8,684.98
| Facility | | $1,028.98 | $1,735.75 | $8,684.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.32 / $1,154.77 / $1,608.86
| Professional | | $912.32 | $1,154.77 | $1,608.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.70 / $945.70 / $945.70
| Facility | | $945.70 | $945.70 | $945.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.64 / $1,339.24 / $2,090.19
| Professional | | $1,033.64 | $1,339.24 | $2,090.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $17,915.68
| Facility | | $55.00 | $55.00 | $17,915.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,024.24 / $7,192.00 / $8,554.65
| Professional | | $7,024.24 | $7,192.00 | $8,554.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.14 / $1,279.44 / $2,221.80
| Facility | | $971.14 | $1,279.44 | $2,221.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.35 / $1,483.21 / $1,744.96
| Professional | | $1,066.35 | $1,483.21 | $1,744.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.04 / $1,032.73 / $1,672.24
| Professional | | $940.04 | $1,032.73 | $1,672.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.88 / $1,296.67 / $2,502.31
| Facility | | $965.88 | $1,296.67 | $2,502.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.25 / $1,374.56 / $2,209.58
| Professional | | $1,039.25 | $1,374.56 | $2,209.58 |
- 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
- $837.57 / $1,151.66 / $1,779.83
| Professional | | $837.57 | $1,151.66 | $1,779.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.37 / $944.77 / $1,297.33
| Professional | | $827.37 | $944.77 | $1,297.33 |