- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,836.00
| Facility | | $969.00 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.63 / $1,433.57 / $2,170.29
| Professional | | $1,264.63 | $1,433.57 | $2,170.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.44 / $2,330.19 / $9,523.43
| Facility | | $1,389.44 | $2,330.19 | $9,523.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.52 / $1,628.14 / $2,268.36
| Professional | | $1,277.52 | $1,628.14 | $2,268.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.01 / $1,178.01 / $1,178.01
| Facility | | $1,178.01 | $1,178.01 | $1,178.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,464.28 / $1,856.29 / $2,897.90
| Professional | | $1,464.28 | $1,856.29 | $2,897.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $20,695.09
| Facility | | $55.00 | $55.00 | $20,695.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,117.84 / $10,285.12 / $11,718.68
| Professional | | $10,117.84 | $10,285.12 | $11,718.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.42 / $1,787.62 / $3,068.34
| Facility | | $1,352.42 | $1,787.62 | $3,068.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.47 / $2,080.07 / $2,447.14
| Professional | | $1,495.47 | $2,080.07 | $2,447.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,394.09 / $2,020.57 / $2,830.82
| Professional | | $1,394.09 | $2,020.57 | $2,830.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.42 / $1,821.47 / $3,140.71
| Facility | | $1,352.42 | $1,821.47 | $3,140.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.61 / $1,905.66 / $2,991.51
| Professional | | $1,473.61 | $1,905.66 | $2,991.51 |
- 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
- $1,154.30 / $1,592.06 / $2,461.44
| Professional | | $1,154.30 | $1,592.06 | $2,461.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.31 / $1,324.59 / $1,833.38
| Professional | | $1,160.31 | $1,324.59 | $1,833.38 |