- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.00 / $2,673.00 / $7,495.00
| Facility | | $803.00 | $2,673.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.84 / $1,053.95 / $1,607.10
| Professional | | $936.84 | $1,053.95 | $1,607.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.25 / $1,201.07 / $1,666.94
| Professional | | $945.25 | $1,201.07 | $1,666.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.83 / $951.83 / $984.61
| Facility | | $951.83 | $951.83 | $984.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,512.62 / $1,929.30 / $2,361.01
| Facility | | $1,512.62 | $1,929.30 | $2,361.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.24 / $1,336.80 / $2,109.00
| Professional | | $976.24 | $1,336.80 | $2,109.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,298.24 / $11,500.00 / $16,394.00
| Facility | | $9,298.24 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,279.28 / $7,438.40 / $8,891.62
| Professional | | $7,279.28 | $7,438.40 | $8,891.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.28 / $1,204.15 / $2,085.41
| Facility | | $976.28 | $1,204.15 | $2,085.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.88 / $1,539.15 / $1,871.12
| Professional | | $1,156.88 | $1,539.15 | $1,871.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.22 / $1,711.88 / $3,698.06
| Professional | | $978.22 | $1,711.88 | $3,698.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.08 / $1,217.09 / $2,322.67
| Facility | | $978.08 | $1,217.09 | $2,322.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.41 / $1,418.42 / $2,564.69
| Professional | | $1,014.41 | $1,418.42 | $2,564.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.00 / $3,239.00 / $7,600.00
| Facility | | $1,190.00 | $3,239.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.56 / $1,122.99 / $1,769.72
| Professional | | $808.56 | $1,122.99 | $1,769.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.57 / $997.91 / $1,346.81
| Professional | | $858.57 | $997.91 | $1,346.81 |