- 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
- $1,260.85 / $1,407.56 / $1,707.86
| Professional | | $1,260.85 | $1,407.56 | $1,707.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.45 / $2,214.76 / $11,015.80
| Facility | | $1,301.45 | $2,214.76 | $11,015.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.25 / $1,445.81 / $2,014.33
| Professional | | $1,142.25 | $1,445.81 | $2,014.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.27 / $1,108.27 / $1,108.27
| Facility | | $1,108.27 | $1,108.27 | $1,108.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,307.46 / $1,730.59 / $2,625.55
| Professional | | $1,307.46 | $1,730.59 | $2,625.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $6,158.19
| Facility | | $55.00 | $55.00 | $6,158.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,193.91 / $10,193.91 / $10,431.08
| Professional | | $10,193.91 | $10,193.91 | $10,431.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.11 / $1,643.38 / $2,794.82
| Facility | | $1,281.11 | $1,643.38 | $2,794.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,586.14 / $1,830.17 / $2,135.19
| Professional | | $1,586.14 | $1,830.17 | $2,135.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.80 / $1,943.80 / $1,943.80
| Professional | | $1,943.80 | $1,943.80 | $1,943.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.11 / $1,649.49 / $3,184.41
| Facility | | $1,281.11 | $1,649.49 | $3,184.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,307.46 / $1,774.94 / $2,884.99
| Professional | | $1,307.46 | $1,774.94 | $2,884.99 |
- 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
- $1,086.00 / $1,445.88 / $2,240.58
| Professional | | $1,086.00 | $1,445.88 | $2,240.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.33 / $1,193.51 / $1,646.87
| Professional | | $1,041.33 | $1,193.51 | $1,646.87 |