- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,893.00
| Facility | | $969.00 | $3,596.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.78 / $1,064.72 / $1,522.66
| Professional | | $926.78 | $1,064.72 | $1,522.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.65 / $1,725.02 / $5,580.91
| Facility | | $1,039.65 | $1,725.02 | $5,580.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.42 / $1,244.48 / $1,727.19
| Professional | | $979.42 | $1,244.48 | $1,727.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.17 / $915.17 / $915.17
| Facility | | $915.17 | $915.17 | $915.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.69 / $1,452.56 / $2,225.58
| Professional | | $1,064.69 | $1,452.56 | $2,225.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,415.40
| Facility | | $55.00 | $55.00 | $8,415.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,624.08 / $7,861.04 / $8,922.83
| Professional | | $7,624.08 | $7,861.04 | $8,922.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.41 / $1,377.77 / $2,272.21
| Facility | | $1,026.41 | $1,377.77 | $2,272.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.31 / $1,576.27 / $1,854.43
| Professional | | $1,339.31 | $1,576.27 | $1,854.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.74 / $1,206.11 / $1,310.20
| Professional | | $1,092.74 | $1,206.11 | $1,310.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.41 / $1,389.69 / $2,560.91
| Facility | | $1,026.41 | $1,389.69 | $2,560.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.69 / $1,481.44 / $2,401.75
| Professional | | $1,064.69 | $1,481.44 | $2,401.75 |
- 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
- $882.31 / $1,190.58 / $1,884.74
| Professional | | $882.31 | $1,190.58 | $1,884.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.28 / $1,005.10 / $1,386.44
| Professional | | $879.28 | $1,005.10 | $1,386.44 |