- 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
- $1,254.06 / $1,405.34 / $2,104.32
| Professional | | $1,254.06 | $1,405.34 | $2,104.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.98 / $1,592.70 / $2,218.42
| Professional | | $1,257.98 | $1,592.70 | $2,218.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.41 / $1,253.41 / $1,299.93
| Facility | | $1,253.41 | $1,253.41 | $1,299.93 |
- 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
- $1,299.56 / $1,781.18 / $2,790.08
| Professional | | $1,299.56 | $1,781.18 | $2,790.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $12,304.40
| Facility | | $55.00 | $55.00 | $12,304.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,634.16 / $9,867.04 / $11,775.98
| Professional | | $9,634.16 | $9,867.04 | $11,775.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.64 / $1,600.91 / $2,784.97
| Facility | | $1,300.64 | $1,600.91 | $2,784.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,531.83 / $2,038.01 / $2,397.65
| Professional | | $1,531.83 | $2,038.01 | $2,397.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.20 / $2,519.90 / $5,006.18
| Professional | | $1,281.20 | $2,519.90 | $5,006.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.47 / $1,619.94 / $3,105.51
| Facility | | $1,301.47 | $1,619.94 | $3,105.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,345.43 / $1,891.46 / $3,404.66
| Professional | | $1,345.43 | $1,891.46 | $3,404.66 |
- 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
- $1,112.40 / $1,512.36 / $2,354.96
| Professional | | $1,112.40 | $1,512.36 | $2,354.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.84 / $1,321.14 / $1,782.54
| Professional | | $1,136.84 | $1,321.14 | $1,782.54 |