- 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
- $1,641.94 / $1,942.55 / $2,979.69
| Professional | | $1,641.94 | $1,942.55 | $2,979.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,019.56 / $3,382.48 / $10,558.84
| Facility | | $2,019.56 | $3,382.48 | $10,558.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,851.32 / $2,359.42 / $3,287.20
| Professional | | $1,851.32 | $2,359.42 | $3,287.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.86 / $1,898.86 / $1,898.86
| Facility | | $1,898.86 | $1,898.86 | $1,898.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.02 / $2,787.45 / $4,058.09
| Professional | | $2,103.02 | $2,787.45 | $4,058.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $27,107.16
| Facility | | $55.00 | $55.00 | $27,107.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,036.52 / $14,205.92 / $18,055.50
| Professional | | $14,036.52 | $14,205.92 | $18,055.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.42 / $2,499.09 / $4,518.46
| Facility | | $1,898.42 | $2,499.09 | $4,518.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,183.26 / $3,036.71 / $3,572.60
| Professional | | $2,183.26 | $3,036.71 | $3,572.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,645.70 / $2,645.70 / $2,645.70
| Professional | | $2,645.70 | $2,645.70 | $2,645.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.42 / $2,538.69 / $4,625.03
| Facility | | $1,898.42 | $2,538.69 | $4,625.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.44 / $2,787.45 / $4,160.17
| Professional | | $2,119.44 | $2,787.45 | $4,160.17 |
- 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
- $1,621.90 / $2,300.53 / $3,627.74
| Professional | | $1,621.90 | $2,300.53 | $3,627.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,693.95 / $1,922.38 / $2,636.33
| Professional | | $1,693.95 | $1,922.38 | $2,636.33 |