- 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
- $1,270.38 / $1,468.46 / $1,755.47
| Professional | | $1,270.38 | $1,468.46 | $1,755.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,332.25 / $2,252.08 / $6,055.00
| Facility | | $1,332.25 | $2,252.08 | $6,055.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.51 / $1,510.87 / $2,104.98
| Professional | | $1,185.51 | $1,510.87 | $2,104.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.98 / $1,185.98 / $1,185.98
| Facility | | $1,185.98 | $1,185.98 | $1,185.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.58 / $1,782.22 / $2,764.47
| Professional | | $1,361.58 | $1,782.22 | $2,764.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $23,228.80
| Facility | | $55.00 | $55.00 | $23,228.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,110.95 / $9,344.48 / $11,170.80
| Professional | | $9,110.95 | $9,344.48 | $11,170.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.18 / $1,742.05 / $2,930.82
| Facility | | $1,356.18 | $1,742.05 | $2,930.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.65 / $1,894.22 / $2,209.92
| Professional | | $1,641.65 | $1,894.22 | $2,209.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.06 / $1,479.47 / $1,555.93
| Professional | | $1,412.06 | $1,479.47 | $1,555.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.18 / $1,757.33 / $3,326.85
| Facility | | $1,356.18 | $1,757.33 | $3,326.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.18 / $1,829.12 / $3,213.74
| Professional | | $1,361.18 | $1,829.12 | $3,213.74 |
- 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
- $1,183.80 / $1,572.92 / $2,367.59
| Professional | | $1,183.80 | $1,572.92 | $2,367.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.77 / $1,237.80 / $1,684.48
| Professional | | $1,077.77 | $1,237.80 | $1,684.48 |