- 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
- $1,046.52 / $1,239.33 / $1,862.22
| Professional | | $1,046.52 | $1,239.33 | $1,862.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.93 / $8,098.24 / $16,692.30
| Facility | | $4,241.93 | $8,098.24 | $16,692.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,048.45 / $1,394.45 / $2,090.32
| Professional | | $1,048.45 | $1,394.45 | $2,090.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.68 / $1,222.68 / $1,222.68
| Facility | | $1,222.68 | $1,222.68 | $1,222.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.04 / $1,737.55 / $2,577.19
| Professional | | $1,348.04 | $1,737.55 | $2,577.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $17,286.24
| Facility | | $55.00 | $55.00 | $17,286.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,288.09 / $13,288.09 / $13,288.09
| Professional | | $13,288.09 | $13,288.09 | $13,288.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.01 / $1,590.34 / $2,970.44
| Facility | | $1,169.01 | $1,590.34 | $2,970.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,643.33 / $1,934.07 / $2,275.38
| Professional | | $1,643.33 | $1,934.07 | $2,275.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.30 / $1,734.30 / $1,734.30
| Professional | | $1,734.30 | $1,734.30 | $1,734.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.01 / $1,596.71 / $2,973.18
| Facility | | $1,169.01 | $1,596.71 | $2,973.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.70 / $1,739.55 / $2,629.04
| Professional | | $1,348.70 | $1,739.55 | $2,629.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.01 / $1,388.81 / $2,248.56
| Professional | | $1,009.01 | $1,388.81 | $2,248.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.86 / $1,223.33 / $1,680.40
| Professional | | $1,078.86 | $1,223.33 | $1,680.40 |