- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,570.00 / $10,893.00
| Facility | | $945.00 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.81 / $1,073.58 / $1,580.40
| Professional | | $957.81 | $1,073.58 | $1,580.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.75 / $1,206.58 / $1,681.05
| Professional | | $946.75 | $1,206.58 | $1,681.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.89 / $883.89 / $897.89
| Facility | | $883.89 | $883.89 | $897.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,024.00 / $4,619.00
| Facility | | $900.00 | $2,024.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.69 / $1,356.38 / $2,142.42
| Professional | | $981.69 | $1,356.38 | $2,142.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,301.29
| Facility | | $55.00 | $55.00 | $8,301.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,531.04 / $7,710.96 / $8,733.45
| Professional | | $7,531.04 | $7,710.96 | $8,733.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.11 / $1,211.31 / $2,188.61
| Facility | | $985.11 | $1,211.31 | $2,188.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.32 / $1,549.05 / $1,822.41
| Professional | | $1,164.32 | $1,549.05 | $1,822.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,235.40 / $2,607.60
| Professional | | $6.00 | $1,235.40 | $2,607.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.38 / $1,223.54 / $2,305.46
| Facility | | $985.38 | $1,223.54 | $2,305.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.67 / $1,455.74 / $2,559.48
| Professional | | $1,020.67 | $1,455.74 | $2,559.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.85 / $1,112.95 / $1,735.54
| Professional | | $829.85 | $1,112.95 | $1,735.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.10 / $1,009.96 / $1,365.78
| Professional | | $864.10 | $1,009.96 | $1,365.78 |