- 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
- $1,514.77 / $1,791.02 / $2,864.58
| Professional | | $1,514.77 | $1,791.02 | $2,864.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,851.73 / $2,343.83 / $3,265.49
| Professional | | $1,851.73 | $2,343.83 | $3,265.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,718.13 / $1,718.13 / $1,718.13
| Facility | | $1,718.13 | $1,718.13 | $1,718.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,110.11 / $2,734.38 / $4,283.54
| Professional | | $2,110.11 | $2,734.38 | $4,283.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,897.00 / $5,897.00 / $13,740.78
| Facility | | $5,897.00 | $5,897.00 | $13,740.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,823.26 / $25,823.26 / $25,823.26
| Professional | | $25,823.26 | $25,823.26 | $25,823.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.36 / $2,570.73 / $4,483.31
| Facility | | $1,888.36 | $2,570.73 | $4,483.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,553.30 / $3,005.04 / $3,535.34
| Professional | | $2,553.30 | $3,005.04 | $3,535.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,732.94 / $2,073.11 / $3,272.56
| Professional | | $1,732.94 | $2,073.11 | $3,272.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.36 / $2,590.16 / $4,766.85
| Facility | | $1,888.36 | $2,590.16 | $4,766.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.17 / $2,806.31 / $4,424.82
| Professional | | $2,159.17 | $2,806.31 | $4,424.82 |
- 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
- $1,698.00 / $2,342.62 / $3,620.41
| Professional | | $1,698.00 | $2,342.62 | $3,620.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.28 / $1,909.72 / $2,643.00
| Professional | | $1,676.28 | $1,909.72 | $2,643.00 |