- 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
- $1,057.73 / $1,189.81 / $1,756.43
| Professional | | $1,057.73 | $1,189.81 | $1,756.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.99 / $1,348.36 / $1,878.09
| Professional | | $1,064.99 | $1,348.36 | $1,878.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.05 / $1,069.05 / $1,105.94
| Facility | | $1,069.05 | $1,069.05 | $1,105.94 |
- 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
- $1,093.04 / $1,506.04 / $2,352.36
| Professional | | $1,093.04 | $1,506.04 | $2,352.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $10,435.12
| Facility | | $55.00 | $55.00 | $10,435.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,169.92 / $8,361.20 / $9,976.73
| Professional | | $8,169.92 | $8,361.20 | $9,976.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.99 / $1,332.07 / $2,349.00
| Facility | | $1,089.99 | $1,332.07 | $2,349.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.22 / $1,727.20 / $2,032.00
| Professional | | $1,298.22 | $1,727.20 | $2,032.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,345.90 / $2,931.50
| Professional | | $7.00 | $1,345.90 | $2,931.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,097.77 / $1,352.95 / $2,622.21
| Facility | | $1,097.77 | $1,352.95 | $2,622.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.13 / $1,597.26 / $2,882.59
| Professional | | $1,136.13 | $1,597.26 | $2,882.59 |
- 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
- $912.44 / $1,262.81 / $1,962.34
| Professional | | $912.44 | $1,262.81 | $1,962.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.47 / $1,119.88 / $1,511.42
| Professional | | $963.47 | $1,119.88 | $1,511.42 |