- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.00 / $3,511.00 / $12,040.00
| Facility | | $921.00 | $3,511.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,966.50 / $2,207.09 / $3,248.42
| Professional | | $1,966.50 | $2,207.09 | $3,248.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,972.38 / $2,496.56 / $3,478.26
| Professional | | $1,972.38 | $2,496.56 | $3,478.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,961.61 / $1,961.61 / $2,034.45
| Facility | | $1,961.61 | $1,961.61 | $2,034.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,619.00
| Facility | | $900.00 | $2,277.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,860.11 / $2,803.87 / $4,429.72
| Professional | | $1,860.11 | $2,803.87 | $4,429.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $19,268.48
| Facility | | $55.00 | $55.00 | $19,268.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,086.08 / $15,461.84 / $18,443.48
| Professional | | $15,086.08 | $15,461.84 | $18,443.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.27 / $2,405.88 / $4,371.33
| Facility | | $1,971.27 | $2,405.88 | $4,371.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.92 / $3,191.63 / $3,754.85
| Professional | | $2,398.92 | $3,191.63 | $3,754.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,132.04 / $3,545.29 / $7,682.60
| Professional | | $2,132.04 | $3,545.29 | $7,682.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,977.85 / $2,421.08 / $4,905.78
| Facility | | $1,977.85 | $2,421.08 | $4,905.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,030.26 / $2,976.35 / $5,336.07
| Professional | | $2,030.26 | $2,976.35 | $5,336.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,703.88 / $2,352.14 / $3,650.85
| Professional | | $1,703.88 | $2,352.14 | $3,650.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,780.36 / $2,068.92 / $2,791.48
| Professional | | $1,780.36 | $2,068.92 | $2,791.48 |