- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.00 / $3,570.00 / $10,836.00
| Facility | | $935.00 | $3,570.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,779.49 / $2,036.31 / $2,436.25
| Professional | | $1,779.49 | $2,036.31 | $2,436.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,658.43 / $2,099.17 / $2,924.61
| Professional | | $1,658.43 | $2,099.17 | $2,924.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,144.30 / $2,580.02 / $3,601.60
| Professional | | $2,144.30 | $2,580.02 | $3,601.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.43 / $1,691.43 / $1,691.43
| Facility | | $1,691.43 | $1,691.43 | $1,691.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,878.17 / $2,511.10 / $4,057.00
| Professional | | $1,878.17 | $2,511.10 | $4,057.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $52,698.62
| Facility | | $55.00 | $55.00 | $52,698.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,966.00 / $22,475.32 / $22,475.32
| Professional | | $20,966.00 | $22,475.32 | $22,475.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,878.17 / $2,409.56 / $4,737.60
| Facility | | $1,878.17 | $2,409.56 | $4,737.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,284.17 / $2,635.59 / $3,074.86
| Professional | | $2,284.17 | $2,635.59 | $3,074.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.33 / $1,878.17 / $3,046.24
| Professional | | $1,683.33 | $1,878.17 | $3,046.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,878.17 / $2,441.62 / $4,799.39
| Facility | | $1,878.17 | $2,441.62 | $4,799.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,878.17 / $2,528.67 / $4,365.47
| Professional | | $1,878.17 | $2,528.67 | $4,365.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $2,547.00 / $9,187.00
| Facility | | $448.00 | $2,547.00 | $9,187.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.83 / $2,092.94 / $3,334.52
| Professional | | $1,534.83 | $2,092.94 | $3,334.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,499.60 / $1,715.44 / $2,349.23
| Professional | | $1,499.60 | $1,715.44 | $2,349.23 |