- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.00 / $3,184.00 / $10,836.00
| Facility | | $872.00 | $3,184.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.97 / $1,189.34 / $1,840.23
| Professional | | $1,045.97 | $1,189.34 | $1,840.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,819.22 / $6,407.31 / $11,447.73
| Facility | | $2,819.22 | $6,407.31 | $11,447.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.07 / $1,377.24 / $1,918.80
| Professional | | $1,088.07 | $1,377.24 | $1,918.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.98 / $1,015.98 / $1,015.98
| Facility | | $1,015.98 | $1,015.98 | $1,015.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.97 / $1,606.50 / $2,423.32
| Professional | | $1,176.97 | $1,606.50 | $2,423.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $10,899.50
| Facility | | $55.00 | $55.00 | $10,899.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,909.98 / $9,930.27 / $10,257.95
| Professional | | $9,909.98 | $9,930.27 | $10,257.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.41 / $1,481.35 / $2,506.77
| Facility | | $1,100.41 | $1,481.35 | $2,506.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,486.90 / $1,749.97 / $2,058.79
| Professional | | $1,486.90 | $1,749.97 | $2,058.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,514.00 / $1,514.00 / $1,514.00
| Professional | | $1,514.00 | $1,514.00 | $1,514.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.41 / $1,482.36 / $2,565.89
| Facility | | $1,100.41 | $1,482.36 | $2,565.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.97 / $1,637.87 / $2,539.07
| Professional | | $1,176.97 | $1,637.87 | $2,539.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,347.00 / $7,600.00
| Facility | | $1,154.00 | $3,347.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.18 / $1,286.88 / $2,083.52
| Professional | | $960.18 | $1,286.88 | $2,083.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.17 / $1,115.29 / $1,539.38
| Professional | | $976.17 | $1,115.29 | $1,539.38 |