- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,511.00 / $10,836.00
| Facility | | $969.00 | $3,511.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.65 / $1,185.57 / $1,715.33
| Professional | | $1,081.65 | $1,185.57 | $1,715.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.58 / $1,916.81 / $6,948.22
| Facility | | $1,122.58 | $1,916.81 | $6,948.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.74 / $1,290.75 / $1,798.30
| Professional | | $1,019.74 | $1,290.75 | $1,798.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $992.25 / $992.25 / $992.25
| Facility | | $992.25 | $992.25 | $992.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.53 / $1,515.54 / $2,341.39
| Professional | | $1,148.53 | $1,515.54 | $2,341.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,957.06
| Facility | | $55.00 | $55.00 | $8,957.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,473.45 / $8,473.45 / $9,320.33
| Professional | | $8,473.45 | $8,473.45 | $9,320.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.25 / $1,505.77 / $2,493.04
| Facility | | $1,109.25 | $1,505.77 | $2,493.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.08 / $1,667.82 / $1,962.14
| Professional | | $1,199.08 | $1,667.82 | $1,962.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,760.20 / $1,760.20 / $1,760.20
| Professional | | $1,760.20 | $1,760.20 | $1,760.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.25 / $1,508.34 / $2,667.53
| Facility | | $1,109.25 | $1,508.34 | $2,667.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.45 / $1,549.93 / $2,545.53
| Professional | | $1,164.45 | $1,549.93 | $2,545.53 |
- 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
- $939.78 / $1,292.19 / $1,997.02
| Professional | | $939.78 | $1,292.19 | $1,997.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.35 / $1,066.07 / $1,471.45
| Professional | | $930.35 | $1,066.07 | $1,471.45 |