- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.00 / $3,186.00 / $10,893.00
| Facility | | $867.00 | $3,186.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.34 / $1,144.58 / $1,743.92
| Professional | | $1,013.34 | $1,144.58 | $1,743.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.89 / $1,840.55 / $4,663.00
| Facility | | $1,085.89 | $1,840.55 | $4,663.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.70 / $1,145.47 / $1,738.16
| Professional | | $874.70 | $1,145.47 | $1,738.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.14 / $1,040.14 / $1,073.15
| Facility | | $1,040.14 | $1,040.14 | $1,073.15 |
- 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
- $1,049.92 / $1,456.39 / $2,254.60
| Professional | | $1,049.92 | $1,456.39 | $2,254.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $7,545.72
| Facility | | $55.00 | $55.00 | $7,545.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,085.69 / $8,085.69 / $9,612.45
| Professional | | $8,085.69 | $8,085.69 | $9,612.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.28 / $1,304.58 / $2,449.39
| Facility | | $1,044.28 | $1,304.58 | $2,449.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.98 / $1,664.35 / $1,958.06
| Professional | | $1,250.98 | $1,664.35 | $1,958.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $2,151.19 / $2,827.00
| Professional | | $5.00 | $2,151.19 | $2,827.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.02 / $1,321.15 / $2,511.94
| Facility | | $1,048.02 | $1,321.15 | $2,511.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.33 / $1,532.54 / $2,770.54
| Professional | | $1,090.33 | $1,532.54 | $2,770.54 |
- 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
- $875.09 / $1,196.61 / $1,894.85
| Professional | | $875.09 | $1,196.61 | $1,894.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.41 / $1,079.27 / $1,457.01
| Professional | | $928.41 | $1,079.27 | $1,457.01 |