- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,836.00
| Facility | | $969.00 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.08 / $1,317.89 / $1,847.56
| Professional | | $1,198.08 | $1,317.89 | $1,847.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,273.09 / $2,151.96 / $5,942.12
| Facility | | $1,273.09 | $2,151.96 | $5,942.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.94 / $1,450.48 / $2,020.84
| Professional | | $1,145.94 | $1,450.48 | $2,020.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.63 / $1,181.63 / $1,181.63
| Facility | | $1,181.63 | $1,181.63 | $1,181.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,261.30 / $1,682.58 / $2,571.11
| Professional | | $1,261.30 | $1,682.58 | $2,571.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,620.80
| Facility | | $55.00 | $55.00 | $11,620.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,098.71 / $9,303.68 / $11,125.65
| Professional | | $9,098.71 | $9,303.68 | $11,125.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.13 / $1,615.10 / $2,851.36
| Facility | | $1,247.13 | $1,615.10 | $2,851.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.11 / $1,925.17 / $2,264.90
| Professional | | $1,384.11 | $1,925.17 | $2,264.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.50 / $1,718.50 / $1,718.50
| Professional | | $1,718.50 | $1,718.50 | $1,718.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.13 / $1,621.27 / $2,986.63
| Facility | | $1,247.13 | $1,621.27 | $2,986.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.32 / $1,704.58 / $2,592.04
| Professional | | $1,291.32 | $1,704.58 | $2,592.04 |
- 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
- $1,020.31 / $1,412.23 / $2,176.66
| Professional | | $1,020.31 | $1,412.23 | $2,176.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.90 / $1,224.90 / $1,683.63
| Professional | | $1,073.90 | $1,224.90 | $1,683.63 |