- 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
- $1,196.95 / $1,269.25 / $1,869.41
| Professional | | $1,196.95 | $1,269.25 | $1,869.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.33 / $2,196.96 / $5,991.47
| Facility | | $1,288.33 | $2,196.96 | $5,991.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,194.68 / $1,522.56 / $2,121.26
| Professional | | $1,194.68 | $1,522.56 | $2,121.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.19 / $1,198.19 / $1,198.19
| Facility | | $1,198.19 | $1,198.19 | $1,198.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.63 / $1,728.18 / $2,642.36
| Professional | | $1,363.63 | $1,728.18 | $2,642.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $10,393.32
| Facility | | $55.00 | $55.00 | $10,393.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,552.00 / $11,552.00 / $11,552.00
| Professional | | $11,552.00 | $11,552.00 | $11,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.95 / $1,653.05 / $2,869.56
| Facility | | $1,259.95 | $1,653.05 | $2,869.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,407.23 / $1,957.33 / $2,302.73
| Professional | | $1,407.23 | $1,957.33 | $2,302.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.58 / $1,525.90 / $2,703.48
| Professional | | $1,207.58 | $1,525.90 | $2,703.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.95 / $1,653.11 / $2,942.85
| Facility | | $1,259.95 | $1,653.11 | $2,942.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.22 / $1,780.16 / $2,761.18
| Professional | | $1,363.22 | $1,780.16 | $2,761.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,000.00 / $8,759.00
| Facility | | $385.00 | $2,000.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.16 / $1,423.96 / $2,306.83
| Professional | | $1,028.16 | $1,423.96 | $2,306.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.83 / $1,246.27 / $1,716.69
| Professional | | $1,091.83 | $1,246.27 | $1,716.69 |