- 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
- $1,047.11 / $1,215.14 / $1,890.05
| Professional | | $1,047.11 | $1,215.14 | $1,890.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,273.09 / $2,218.98 / $11,036.86
| Facility | | $1,273.09 | $2,218.98 | $11,036.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,178.17 / $1,501.52 / $2,174.04
| Professional | | $1,178.17 | $1,501.52 | $2,174.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.31 / $1,223.31 / $1,223.31
| Facility | | $1,223.31 | $1,223.31 | $1,223.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.65 / $1,728.26 / $2,577.94
| Professional | | $1,332.65 | $1,728.26 | $2,577.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $14,415.80
| Facility | | $55.00 | $55.00 | $14,415.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,895.07 / $10,053.11 / $11,494.13
| Professional | | $9,895.07 | $10,053.11 | $11,494.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.56 / $1,570.40 / $2,853.65
| Facility | | $1,185.56 | $1,570.40 | $2,853.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.58 / $1,935.56 / $2,277.13
| Professional | | $1,391.58 | $1,935.56 | $2,277.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.70 / $1,465.70 / $1,465.70
| Professional | | $1,465.70 | $1,465.70 | $1,465.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.56 / $1,576.19 / $2,972.15
| Facility | | $1,185.56 | $1,576.19 | $2,972.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.92 / $1,740.40 / $2,629.74
| Professional | | $1,338.92 | $1,740.40 | $2,629.74 |
- 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
- $1,009.55 / $1,389.19 / $2,222.11
| Professional | | $1,009.55 | $1,389.19 | $2,222.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.70 / $1,224.27 / $1,681.67
| Professional | | $1,079.70 | $1,224.27 | $1,681.67 |