- 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
- $1,193.83 / $1,348.26 / $2,021.81
| Professional | | $1,193.83 | $1,348.26 | $2,021.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.33 / $1,497.62 / $2,040.78
| Professional | | $1,189.33 | $1,497.62 | $2,040.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.23 / $1,173.23 / $1,192.85
| Facility | | $1,173.23 | $1,173.23 | $1,192.85 |
- 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
- $1,235.03 / $1,727.16 / $2,710.42
| Professional | | $1,235.03 | $1,727.16 | $2,710.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,773.44
| Facility | | $55.00 | $55.00 | $11,773.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,470.21 / $11,470.21 / $11,470.21
| Professional | | $11,470.21 | $11,470.21 | $11,470.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.03 / $1,538.00 / $2,874.13
| Facility | | $1,248.03 | $1,538.00 | $2,874.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.04 / $1,921.21 / $2,260.23
| Professional | | $1,444.04 | $1,921.21 | $2,260.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,762.10 / $3,237.00
| Professional | | $7.00 | $1,762.10 | $3,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.03 / $1,560.68 / $2,947.53
| Facility | | $1,248.03 | $1,560.68 | $2,947.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.41 / $1,815.02 / $3,221.27
| Professional | | $1,297.41 | $1,815.02 | $3,221.27 |
- 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
- $1,079.51 / $1,426.23 / $2,274.29
| Professional | | $1,079.51 | $1,426.23 | $2,274.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.69 / $1,253.27 / $1,693.93
| Professional | | $1,071.69 | $1,253.27 | $1,693.93 |