- 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
- $1,004.62 / $1,129.89 / $1,685.79
| Professional | | $1,004.62 | $1,129.89 | $1,685.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.60 / $1,890.37 / $12,316.06
| Facility | | $1,053.60 | $1,890.37 | $12,316.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.12 / $1,280.17 / $1,783.10
| Professional | | $1,011.12 | $1,280.17 | $1,783.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.26 / $1,017.26 / $1,051.32
| Facility | | $1,017.26 | $1,017.26 | $1,051.32 |
- 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
- $1,004.02 / $1,429.60 / $2,234.73
| Professional | | $1,004.02 | $1,429.60 | $2,234.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $9,913.12
| Facility | | $55.00 | $55.00 | $9,913.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,759.68 / $7,941.36 / $9,477.83
| Professional | | $7,759.68 | $7,941.36 | $9,477.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.68 / $1,257.09 / $2,365.31
| Facility | | $1,019.68 | $1,257.09 | $2,365.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.13 / $1,608.44 / $1,930.12
| Professional | | $1,233.13 | $1,608.44 | $1,930.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,213.90 / $2,787.00
| Professional | | $7.00 | $1,213.90 | $2,787.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.46 / $1,265.40 / $2,491.62
| Facility | | $1,028.46 | $1,265.40 | $2,491.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.15 / $1,515.32 / $2,737.34
| Professional | | $1,055.15 | $1,515.32 | $2,737.34 |
- 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
- $873.66 / $1,200.71 / $1,863.39
| Professional | | $873.66 | $1,200.71 | $1,863.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.17 / $1,063.74 / $1,435.81
| Professional | | $915.17 | $1,063.74 | $1,435.81 |