- 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
- $1,751.32 / $2,056.19 / $3,082.62
| Professional | | $1,751.32 | $2,056.19 | $3,082.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,033.22 / $3,609.54 / $8,589.79
| Facility | | $2,033.22 | $3,609.54 | $8,589.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,002.75 / $3,355.60 / $4,277.35
| Professional | | $2,002.75 | $3,355.60 | $4,277.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.31 / $2,009.31 / $2,009.31
| Facility | | $2,009.31 | $2,009.31 | $2,009.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,168.58 / $2,800.43 / $4,083.53
| Professional | | $2,168.58 | $2,800.43 | $4,083.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $38,581.28
| Facility | | $55.00 | $55.00 | $38,581.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,020.94 / $15,158.08 / $19,310.55
| Professional | | $15,020.94 | $15,158.08 | $19,310.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,919.67 / $2,546.14 / $4,843.18
| Facility | | $1,919.67 | $2,546.14 | $4,843.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,332.69 / $3,244.58 / $3,817.15
| Professional | | $2,332.69 | $3,244.58 | $3,817.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,473.69 / $2,473.69 / $2,473.69
| Professional | | $2,473.69 | $2,473.69 | $2,473.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,919.67 / $2,570.71 / $4,957.41
| Facility | | $1,919.67 | $2,570.71 | $4,957.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,205.73 / $2,834.66 / $4,308.14
| Professional | | $2,205.73 | $2,834.66 | $4,308.14 |
- 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
- $1,708.94 / $2,352.84 / $3,809.36
| Professional | | $1,708.94 | $2,352.84 | $3,809.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,809.90 / $2,055.08 / $2,815.20
| Professional | | $1,809.90 | $2,055.08 | $2,815.20 |