- 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
- $1,115.25 / $1,215.83 / $1,757.79
| Professional | | $1,115.25 | $1,215.83 | $1,757.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.08 / $1,983.53 / $9,276.62
| Facility | | $1,161.08 | $1,983.53 | $9,276.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.11 / $1,229.69 / $2,297.77
| Professional | | $893.11 | $1,229.69 | $2,297.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.37 / $1,016.37 / $1,016.37
| Facility | | $1,016.37 | $1,016.37 | $1,016.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.30 / $1,554.28 / $2,401.14
| Professional | | $1,177.30 | $1,554.28 | $2,401.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $10,496.96
| Facility | | $55.00 | $55.00 | $10,496.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,559.12 / $10,108.39 / $10,441.96
| Professional | | $9,559.12 | $10,108.39 | $10,441.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.56 / $1,509.67 / $2,564.08
| Facility | | $1,137.56 | $1,509.67 | $2,564.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.69 / $1,710.39 / $2,012.22
| Professional | | $1,229.69 | $1,710.39 | $2,012.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,658.60 / $1,658.60 / $1,658.60
| Professional | | $1,658.60 | $1,658.60 | $1,658.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.56 / $1,530.09 / $2,735.62
| Facility | | $1,137.56 | $1,530.09 | $2,735.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.30 / $1,584.04 / $2,486.80
| Professional | | $1,177.30 | $1,584.04 | $2,486.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.38 / $1,330.42 / $2,057.31
| Professional | | $970.38 | $1,330.42 | $2,057.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.09 / $1,093.33 / $1,508.91
| Professional | | $954.09 | $1,093.33 | $1,508.91 |