- 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
- $1,892.61 / $2,250.13 / $2,689.00
| Professional | | $1,892.61 | $2,250.13 | $2,689.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,711.53 / $2,944.55 / $3,622.43
| Facility | | $2,711.53 | $2,944.55 | $3,622.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.55 / $2,306.71 / $3,153.02
| Professional | | $1,815.55 | $2,306.71 | $3,153.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.08 / $1,864.08 / $1,864.08
| Facility | | $1,864.08 | $1,864.08 | $1,864.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,068.94 / $2,700.70 / $4,241.78
| Professional | | $2,068.94 | $2,700.70 | $4,241.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $46,919.88
| Facility | | $55.00 | $55.00 | $46,919.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,046.00 / $17,046.00 / $17,047.95
| Professional | | $17,046.00 | $17,046.00 | $17,047.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.14 / $2,460.08 / $4,490.97
| Facility | | $1,976.14 | $2,460.08 | $4,490.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,516.29 / $2,903.42 / $3,387.32
| Professional | | $2,516.29 | $2,903.42 | $3,387.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,989.70 / $2,989.70 / $2,989.70
| Professional | | $2,989.70 | $2,989.70 | $2,989.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.14 / $2,492.62 / $5,096.26
| Facility | | $1,976.14 | $2,492.62 | $5,096.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,068.94 / $2,780.47 / $4,545.84
| Professional | | $2,068.94 | $2,780.47 | $4,545.84 |
- 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
- $1,698.34 / $2,224.30 / $3,471.56
| Professional | | $1,698.34 | $2,224.30 | $3,471.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.99 / $1,892.37 / $2,588.48
| Professional | | $1,651.99 | $1,892.37 | $2,588.48 |