- 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
- $1,870.47 / $2,141.33 / $2,558.60
| Professional | | $1,870.47 | $2,141.33 | $2,558.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,736.61 / $2,198.12 / $3,062.48
| Professional | | $1,736.61 | $2,198.12 | $3,062.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,782.41 / $2,700.39 / $3,761.78
| Professional | | $1,782.41 | $2,700.39 | $3,761.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.17 / $1,788.17 / $1,788.17
| Facility | | $1,788.17 | $1,788.17 | $1,788.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,960.27 / $2,574.46 / $4,037.34
| Professional | | $1,960.27 | $2,574.46 | $4,037.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $44,577.54
| Facility | | $55.00 | $55.00 | $44,577.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,592.52 / $17,592.52 / $17,592.52
| Professional | | $17,592.52 | $17,592.52 | $17,592.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,885.24 / $2,370.46 / $4,293.08
| Facility | | $1,885.24 | $2,370.46 | $4,293.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,388.46 / $2,755.92 / $3,215.24
| Professional | | $2,388.46 | $2,755.92 | $3,215.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,779.30 / $1,960.27 / $3,184.10
| Professional | | $1,779.30 | $1,960.27 | $3,184.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,885.24 / $2,373.67 / $5,300.12
| Facility | | $1,885.24 | $2,373.67 | $5,300.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,960.27 / $2,656.20 / $4,430.53
| Professional | | $1,960.27 | $2,656.20 | $4,430.53 |
- 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
- $1,619.12 / $2,148.51 / $3,440.63
| Professional | | $1,619.12 | $2,148.51 | $3,440.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,568.06 / $1,795.47 / $2,458.38
| Professional | | $1,568.06 | $1,795.47 | $2,458.38 |