- 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
- $1,034.23 / $1,170.60 / $1,717.49
| Professional | | $1,034.23 | $1,170.60 | $1,717.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,188.78 / $2,033.10 / $5,458.68
| Facility | | $1,188.78 | $2,033.10 | $5,458.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.08 / $1,366.33 / $1,903.60
| Professional | | $1,072.08 | $1,366.33 | $1,903.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.75 / $1,103.75 / $1,103.75
| Facility | | $1,103.75 | $1,103.75 | $1,103.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.72 / $1,593.84 / $2,446.92
| Professional | | $1,202.72 | $1,593.84 | $2,446.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $12,325.59
| Facility | | $55.00 | $55.00 | $12,325.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,922.94 / $10,167.29 / $10,250.39
| Professional | | $9,922.94 | $10,167.29 | $10,250.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.75 / $1,493.75 / $2,612.21
| Facility | | $1,152.75 | $1,493.75 | $2,612.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,524.74 / $1,794.51 / $2,111.17
| Professional | | $1,524.74 | $1,794.51 | $2,111.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.30 / $1,603.30 / $1,603.30
| Professional | | $1,603.30 | $1,603.30 | $1,603.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.75 / $1,519.17 / $2,673.83
| Facility | | $1,152.75 | $1,519.17 | $2,673.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.72 / $1,624.03 / $2,606.69
| Professional | | $1,202.72 | $1,624.03 | $2,606.69 |
- 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
- $953.40 / $1,280.28 / $2,066.35
| Professional | | $953.40 | $1,280.28 | $2,066.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.02 / $1,141.94 / $1,579.32
| Professional | | $1,001.02 | $1,141.94 | $1,579.32 |