- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,570.00 / $10,836.00
| Facility | | $969.00 | $3,570.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,724.20 / $2,049.23 / $2,453.33
| Professional | | $1,724.20 | $2,049.23 | $2,453.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.81 / $2,112.80 / $2,879.07
| Professional | | $1,657.81 | $2,112.80 | $2,879.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,158.08 / $2,596.60 / $3,622.88
| Professional | | $2,158.08 | $2,596.60 | $3,622.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.79 / $1,706.79 / $1,706.79
| Facility | | $1,706.79 | $1,706.79 | $1,706.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.59 / $2,456.69 / $4,111.38
| Professional | | $1,889.59 | $2,456.69 | $4,111.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $53,072.50
| Facility | | $55.00 | $55.00 | $53,072.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,432.00 / $19,432.00 / $19,432.00
| Professional | | $19,432.00 | $19,432.00 | $19,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,889.59 / $2,333.76 / $4,391.28
| Facility | | $1,889.59 | $2,333.76 | $4,391.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.73 / $2,653.55 / $3,095.80
| Professional | | $2,299.73 | $2,653.55 | $3,095.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.32 / $1,851.14 / $3,052.90
| Professional | | $1,698.32 | $1,851.14 | $3,052.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,889.59 / $2,451.48 / $4,653.47
| Facility | | $1,889.59 | $2,451.48 | $4,653.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.59 / $2,539.73 / $4,202.75
| Professional | | $1,889.59 | $2,539.73 | $4,202.75 |
- 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
- $1,537.99 / $2,018.61 / $3,217.73
| Professional | | $1,537.99 | $2,018.61 | $3,217.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.81 / $1,726.46 / $2,365.71
| Professional | | $1,509.81 | $1,726.46 | $2,365.71 |