- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,774.00 / $13,401.00
| Facility | | $1,048.00 | $3,774.00 | $13,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.23 / $1,201.54 / $1,876.76
| Professional | | $1,005.23 | $1,201.54 | $1,876.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,645.23 / $4,516.79 / $8,403.96
| Facility | | $2,645.23 | $4,516.79 | $8,403.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.56 / $974.56 / $1,146.54
| Professional | | $974.56 | $974.56 | $1,146.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,364.20 / $1,364.20 / $1,364.20
| Facility | | $1,364.20 | $1,364.20 | $1,364.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.55 / $1,590.02 / $2,443.78
| Professional | | $1,138.55 | $1,590.02 | $2,443.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,034.36
| Facility | | $55.00 | $55.00 | $15,034.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,587.96 / $9,587.96 / $10,295.48
| Professional | | $9,587.96 | $9,587.96 | $10,295.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.48 / $1,268.40 / $2,041.88
| Facility | | $1,044.48 | $1,268.40 | $2,041.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.86 / $1,138.51 / $9,074.00
| Professional | | $1,094.86 | $1,138.51 | $9,074.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.80 / $1,308.27 / $2,082.76
| Facility | | $1,056.80 | $1,308.27 | $2,082.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.67 / $1,603.79 / $2,469.80
| Professional | | $1,153.67 | $1,603.79 | $2,469.80 |
- 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
- $820.43 / $1,155.45 / $1,883.88
| Professional | | $820.43 | $1,155.45 | $1,883.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.86 / $1,189.33 / $1,504.62
| Professional | | $1,094.86 | $1,189.33 | $1,504.62 |