- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.41 / $1,635.00 / $10,561.00
| Facility | | $959.41 | $1,635.00 | $10,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.74 / $1,008.50 / $1,899.32
| Professional | | $836.74 | $1,008.50 | $1,899.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.86 / $3,066.86 / $4,382.17
| Facility | | $3,066.86 | $3,066.86 | $4,382.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.52 / $1,494.37 / $2,593.94
| Professional | | $1,066.52 | $1,494.37 | $2,593.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.76 / $1,369.43 / $2,465.46
| Professional | | $1,005.76 | $1,369.43 | $2,465.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.41 / $1,246.64 / $1,774.74
| Facility | | $959.41 | $1,246.64 | $1,774.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.58 / $1,222.00 / $1,268.00
| Professional | | $1,189.58 | $1,222.00 | $1,268.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $1,286.09 / $2,578.40
| Professional | | $4.00 | $1,286.09 | $2,578.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.61 / $1,232.40 / $2,390.71
| Professional | | $848.61 | $1,232.40 | $2,390.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $17,381.18 / $19,913.50
| Facility | | $55.00 | $17,381.18 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,097.52 / $7,097.52 / $8,460.08
| Professional | | $7,097.52 | $7,097.52 | $8,460.08 |