- 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
- $1,667.63 / $1,861.19 / $2,754.30
| Professional | | $1,667.63 | $1,861.19 | $2,754.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,171.46 / $7,518.32 / $14,503.08
| Facility | | $4,171.46 | $7,518.32 | $14,503.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,740.92 / $2,203.58 / $2,510.69
| Professional | | $1,740.92 | $2,203.58 | $2,510.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.06 / $1,600.06 / $1,600.06
| Facility | | $1,600.06 | $1,600.06 | $1,600.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,919.13 / $2,528.91 / $3,967.46
| Professional | | $1,919.13 | $2,528.91 | $3,967.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $25,675.68
| Facility | | $55.00 | $55.00 | $25,675.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,283.70 / $14,283.70 / $15,758.03
| Professional | | $14,283.70 | $14,283.70 | $15,758.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,822.13 / $2,451.06 / $4,173.89
| Facility | | $1,822.13 | $2,451.06 | $4,173.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,374.59 / $2,794.71 / $3,287.90
| Professional | | $2,374.59 | $2,794.71 | $3,287.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,507.69 / $2,507.69 / $2,507.69
| Professional | | $2,507.69 | $2,507.69 | $2,507.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,822.13 / $2,487.58 / $4,629.68
| Facility | | $1,822.13 | $2,487.58 | $4,629.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,919.24 / $2,562.42 / $4,075.40
| Professional | | $1,919.24 | $2,562.42 | $4,075.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,575.54 / $2,151.67 / $3,325.30
| Professional | | $1,575.54 | $2,151.67 | $3,325.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.96 / $1,776.97 / $2,464.19
| Professional | | $1,558.96 | $1,776.97 | $2,464.19 |