- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.00 / $2,236.00 / $7,513.00
| Facility | | $732.00 | $2,236.00 | $7,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.50 / $1,731.01 / $2,471.27
| Professional | | $1,521.50 | $1,731.01 | $2,471.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,272.77 / $3,971.98 / $7,369.40
| Facility | | $2,272.77 | $3,971.98 | $7,369.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.33 / $2,021.99 / $2,846.28
| Professional | | $1,591.33 | $2,021.99 | $2,846.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.96 / $1,586.96 / $1,586.96
| Facility | | $1,586.96 | $1,586.96 | $1,586.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.46 / $2,300.07 / $3,480.46
| Professional | | $1,734.46 | $2,300.07 | $3,480.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,801.68
| Facility | | $55.00 | $55.00 | $15,801.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,514.24 / $12,860.16 / $14,662.88
| Professional | | $12,514.24 | $12,860.16 | $14,662.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,633.50 / $2,112.63 / $3,908.01
| Facility | | $1,633.50 | $2,112.63 | $3,908.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,199.23 / $2,588.33 / $3,045.10
| Professional | | $2,199.23 | $2,588.33 | $3,045.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,125.80 / $2,125.80 / $2,125.80
| Professional | | $2,125.80 | $2,125.80 | $2,125.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,633.50 / $2,119.39 / $4,000.18
| Facility | | $1,633.50 | $2,119.39 | $4,000.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.46 / $2,378.94 / $3,618.32
| Professional | | $1,734.46 | $2,378.94 | $3,618.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,382.55 / $1,914.14 / $2,990.71
| Professional | | $1,382.55 | $1,914.14 | $2,990.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.83 / $1,647.51 / $2,277.80
| Professional | | $1,443.83 | $1,647.51 | $2,277.80 |