- 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
- $1,201.53 / $1,342.14 / $2,029.82
| Professional | | $1,201.53 | $1,342.14 | $2,029.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.96 / $1,521.39 / $2,119.63
| Professional | | $1,201.96 | $1,521.39 | $2,119.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.08 / $1,192.08 / $1,239.28
| Facility | | $1,192.08 | $1,192.08 | $1,239.28 |
- 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
- $1,245.99 / $1,735.95 / $2,679.72
| Professional | | $1,245.99 | $1,735.95 | $2,679.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,765.76
| Facility | | $55.00 | $55.00 | $11,765.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,211.20 / $9,422.95 / $11,277.23
| Professional | | $9,211.20 | $9,422.95 | $11,277.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.88 / $1,552.64 / $2,667.84
| Facility | | $1,241.88 | $1,552.64 | $2,667.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.00 / $1,950.41 / $2,294.60
| Professional | | $1,466.00 | $1,950.41 | $2,294.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,742.60 / $3,289.60
| Professional | | $7.00 | $1,742.60 | $3,289.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.36 / $1,559.34 / $2,977.26
| Facility | | $1,242.36 | $1,559.34 | $2,977.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.66 / $1,814.90 / $3,253.60
| Professional | | $1,298.66 | $1,814.90 | $3,253.60 |
- 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
- $1,043.34 / $1,432.51 / $2,256.55
| Professional | | $1,043.34 | $1,432.51 | $2,256.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.99 / $1,264.03 / $1,704.98
| Professional | | $1,087.99 | $1,264.03 | $1,704.98 |