- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,570.00 / $10,836.00
| Facility | | $969.00 | $3,570.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.84 / $1,958.84 / $3,088.60
| Professional | | $1,743.84 | $1,958.84 | $3,088.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,987.03 / $3,549.87 / $13,373.39
| Facility | | $1,987.03 | $3,549.87 | $13,373.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,888.62 / $2,449.42 / $3,524.74
| Professional | | $1,888.62 | $2,449.42 | $3,524.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,071.17 / $2,071.17 / $2,071.17
| Facility | | $2,071.17 | $2,071.17 | $2,071.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.27 / $2,651.07 / $3,819.80
| Professional | | $2,017.27 | $2,651.07 | $3,819.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $28,083.36
| Facility | | $55.00 | $55.00 | $28,083.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,424.80 / $14,837.84 / $18,473.40
| Professional | | $14,424.80 | $14,837.84 | $18,473.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.43 / $2,365.67 / $4,724.13
| Facility | | $1,824.43 | $2,365.67 | $4,724.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.02 / $3,126.78 / $3,678.57
| Professional | | $2,248.02 | $3,126.78 | $3,678.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,174.19 / $2,174.19 / $2,174.19
| Professional | | $2,174.19 | $2,174.19 | $2,174.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.05 / $2,406.48 / $4,844.79
| Facility | | $1,844.05 | $2,406.48 | $4,844.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,002.44 / $2,728.48 / $4,252.13
| Professional | | $2,002.44 | $2,728.48 | $4,252.13 |
- 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
- $1,557.38 / $2,188.11 / $3,640.14
| Professional | | $1,557.38 | $2,188.11 | $3,640.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,744.19 / $1,971.39 / $2,725.03
| Professional | | $1,744.19 | $1,971.39 | $2,725.03 |