- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,570.00 / $10,836.00
| Facility | | $969.00 | $3,570.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,175.55 / $1,281.34 / $1,764.96
| Professional | | $1,175.55 | $1,281.34 | $1,764.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,220.77 / $2,058.66 / $5,649.16
| Facility | | $1,220.77 | $2,058.66 | $5,649.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.56 / $1,425.55 / $1,986.11
| Professional | | $1,118.56 | $1,425.55 | $1,986.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.43 / $1,125.43 / $1,125.43
| Facility | | $1,125.43 | $1,125.43 | $1,125.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.26 / $1,635.82 / $2,530.96
| Professional | | $1,251.26 | $1,635.82 | $2,530.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,063.60
| Facility | | $55.00 | $55.00 | $11,063.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,662.16 / $8,856.87 / $10,590.38
| Professional | | $8,662.16 | $8,856.87 | $10,590.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.28 / $1,529.89 / $2,710.78
| Facility | | $1,187.28 | $1,529.89 | $2,710.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,317.57 / $1,832.62 / $2,156.02
| Professional | | $1,317.57 | $1,832.62 | $2,156.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.80 / $1,597.80 / $1,597.80
| Professional | | $1,597.80 | $1,597.80 | $1,597.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.91 / $1,543.46 / $2,943.25
| Facility | | $1,182.91 | $1,543.46 | $2,943.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.05 / $1,636.46 / $2,624.11
| Professional | | $1,255.05 | $1,636.46 | $2,624.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,546.00 / $9,000.00
| Facility | | $495.00 | $2,546.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.96 / $1,350.92 / $2,187.19
| Professional | | $1,002.96 | $1,350.92 | $2,187.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.28 / $1,165.80 / $1,602.83
| Professional | | $1,022.28 | $1,165.80 | $1,602.83 |