- 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
- $2,004.02 / $2,411.23 / $3,170.54
| Professional | | $2,004.02 | $2,411.23 | $3,170.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.60 / $3,623.21 / $8,585.00
| Facility | | $2,187.60 | $3,623.21 | $8,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,777.55 / $2,543.69 / $4,329.20
| Professional | | $1,777.55 | $2,543.69 | $4,329.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,877.62 / $1,877.62 / $1,877.62
| Facility | | $1,877.62 | $1,877.62 | $1,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,183.66 / $2,893.46 / $4,488.74
| Professional | | $2,183.66 | $2,893.46 | $4,488.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $17,305.18
| Facility | | $55.00 | $55.00 | $17,305.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,673.04 / $16,118.24 / $18,214.28
| Professional | | $15,673.04 | $16,118.24 | $18,214.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,085.34 / $2,629.34 / $4,833.24
| Facility | | $2,085.34 | $2,629.34 | $4,833.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,319.54 / $3,226.27 / $3,795.61
| Professional | | $2,319.54 | $3,226.27 | $3,795.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,410.00 / $2,410.00 / $2,410.00
| Professional | | $2,410.00 | $2,410.00 | $2,410.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $2,635.00 / $5,240.54
| Facility | | $2,073.00 | $2,635.00 | $5,240.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,199.19 / $2,926.40 / $4,590.05
| Professional | | $2,199.19 | $2,926.40 | $4,590.05 |
- 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
- $1,805.47 / $2,485.92 / $3,810.38
| Professional | | $1,805.47 | $2,485.92 | $3,810.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,799.69 / $2,045.51 / $2,846.99
| Professional | | $1,799.69 | $2,045.51 | $2,846.99 |