- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.00 / $3,620.00 / $12,480.00
| Facility | | $1,086.00 | $3,620.00 | $12,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,933.06 / $2,206.21 / $3,650.11
| Professional | | $1,933.06 | $2,206.21 | $3,650.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,174.15 / $3,634.56 / $11,176.65
| Facility | | $2,174.15 | $3,634.56 | $11,176.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,815.88 / $1,848.53
| Facility | | $80.00 | $1,815.88 | $1,848.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,447.00 / $2,447.00 / $2,447.00
| Facility | | $2,447.00 | $2,447.00 | $2,447.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.12 / $2,876.10 / $4,523.79
| Professional | | $2,179.12 | $2,876.10 | $4,523.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $19,610.56
| Facility | | $55.00 | $55.00 | $19,610.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,628.38 / $22,628.38 / $22,628.38
| Professional | | $22,628.38 | $22,628.38 | $22,628.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.84 / $2,860.56 / $4,776.76
| Facility | | $2,089.84 | $2,860.56 | $4,776.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,616.84 / $3,140.21 / $3,893.85
| Professional | | $2,616.84 | $3,140.21 | $3,893.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,755.50 / $2,755.50 / $2,755.50
| Professional | | $2,755.50 | $2,755.50 | $2,755.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,091.27 / $2,868.77 / $4,887.05
| Facility | | $2,091.27 | $2,868.77 | $4,887.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.40 / $3,017.76 / $4,581.96
| Professional | | $2,179.40 | $3,017.76 | $4,581.96 |
- 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
- $1,742.46 / $2,355.73 / $3,685.51
| Professional | | $1,742.46 | $2,355.73 | $3,685.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,786.71 / $2,039.17 / $2,823.21
| Professional | | $1,786.71 | $2,039.17 | $2,823.21 |