- 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
- $935.69 / $1,075.33 / $1,623.39
| Professional | | $935.69 | $1,075.33 | $1,623.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.47 / $1,758.01 / $7,820.85
| Facility | | $1,042.47 | $1,758.01 | $7,820.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.65 / $1,256.21 / $1,743.47
| Professional | | $988.65 | $1,256.21 | $1,743.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.23 / $922.23 / $922.23
| Facility | | $922.23 | $922.23 | $922.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.34 / $1,459.86 / $2,247.73
| Professional | | $1,069.34 | $1,459.86 | $2,247.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,496.53
| Facility | | $55.00 | $55.00 | $8,496.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,695.28 / $7,932.80 / $9,013.35
| Professional | | $7,695.28 | $7,932.80 | $9,013.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.33 / $1,391.38 / $2,280.63
| Facility | | $1,036.33 | $1,391.38 | $2,280.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,352.34 / $1,591.60 / $1,872.47
| Professional | | $1,352.34 | $1,591.60 | $1,872.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.18 / $1,217.54 / $1,300.20
| Professional | | $1,101.18 | $1,217.54 | $1,300.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.33 / $1,400.36 / $2,481.50
| Facility | | $1,036.33 | $1,400.36 | $2,481.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.34 / $1,491.00 / $2,402.73
| Professional | | $1,069.34 | $1,491.00 | $2,402.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.11 / $1,183.34 / $1,896.40
| Professional | | $859.11 | $1,183.34 | $1,896.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.83 / $1,014.62 / $1,399.91
| Professional | | $887.83 | $1,014.62 | $1,399.91 |