- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $12,040.00
| Facility | | $969.00 | $3,682.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.67 / $1,198.58 / $1,670.61
| Professional | | $1,082.67 | $1,198.58 | $1,670.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.72 / $1,926.65 / $8,646.14
| Facility | | $1,141.72 | $1,926.65 | $8,646.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.75 / $1,212.67 / $2,259.42
| Professional | | $880.75 | $1,212.67 | $2,259.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.84 / $1,002.84 / $1,002.84
| Facility | | $1,002.84 | $1,002.84 | $1,002.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.21 / $1,532.20 / $2,362.46
| Professional | | $1,161.21 | $1,532.20 | $2,362.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $10,348.95
| Facility | | $55.00 | $55.00 | $10,348.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,267.68 / $8,455.76 / $9,422.40
| Professional | | $8,267.68 | $8,455.76 | $9,422.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.52 / $1,489.50 / $2,521.29
| Facility | | $1,121.52 | $1,489.50 | $2,521.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.26 / $1,686.14 / $1,983.69
| Professional | | $1,212.26 | $1,686.14 | $1,983.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.80 / $1,618.80 / $1,618.80
| Professional | | $1,618.80 | $1,618.80 | $1,618.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.52 / $1,506.43 / $2,696.83
| Facility | | $1,121.52 | $1,506.43 | $2,696.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.21 / $1,556.37 / $2,390.88
| Professional | | $1,161.21 | $1,556.37 | $2,390.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.46 / $1,306.88 / $2,019.72
| Professional | | $950.46 | $1,306.88 | $2,019.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.57 / $1,077.81 / $1,487.59
| Professional | | $940.57 | $1,077.81 | $1,487.59 |