- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $3,742.00 / $13,004.00
| Facility | | $1,068.00 | $3,742.00 | $13,004.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.86 / $1,202.18 / $1,676.00
| Professional | | $1,082.86 | $1,202.18 | $1,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.40 / $1,905.74 / $5,262.24
| Facility | | $1,148.40 | $1,905.74 | $5,262.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.54 / $1,075.57 / $1,326.07
| Professional | | $1,026.54 | $1,075.57 | $1,326.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.48 / $1,005.48 / $1,005.48
| Facility | | $1,005.48 | $1,005.48 | $1,005.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.97 / $1,537.32 / $2,374.37
| Professional | | $1,164.97 | $1,537.32 | $2,374.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $10,381.52
| Facility | | $55.00 | $55.00 | $10,381.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,293.12 / $8,483.04 / $9,454.20
| Professional | | $8,293.12 | $8,483.04 | $9,454.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.86 / $1,494.52 / $2,528.92
| Facility | | $1,124.86 | $1,494.52 | $2,528.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.16 / $1,691.57 / $1,990.08
| Professional | | $1,216.16 | $1,691.57 | $1,990.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.90 / $1,656.90 / $1,656.90
| Professional | | $1,656.90 | $1,656.90 | $1,656.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.86 / $1,511.89 / $2,704.91
| Facility | | $1,124.86 | $1,511.89 | $2,704.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.97 / $1,561.10 / $2,579.98
| Professional | | $1,164.97 | $1,561.10 | $2,579.98 |
- 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
- $946.66 / $1,310.85 / $2,025.86
| Professional | | $946.66 | $1,310.85 | $2,025.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.60 / $1,081.29 / $1,492.32
| Professional | | $943.60 | $1,081.29 | $1,492.32 |