- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $10,836.00
| Facility | | $969.00 | $3,682.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,142.28 / $2,594.06 / $3,552.20
| Professional | | $2,142.28 | $2,594.06 | $3,552.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,391.03 / $3,960.15 / $9,037.00
| Facility | | $2,391.03 | $3,960.15 | $9,037.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,161.06 / $2,735.38 / $3,811.00
| Professional | | $2,161.06 | $2,735.38 | $3,811.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,191.04 / $2,191.04 / $2,191.04
| Facility | | $2,191.04 | $2,191.04 | $2,191.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,318.48 / $3,139.63 / $4,914.57
| Professional | | $2,318.48 | $3,139.63 | $4,914.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $42,196.48
| Facility | | $55.00 | $55.00 | $42,196.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,548.64 / $16,968.24 / $20,198.93
| Professional | | $16,548.64 | $16,968.24 | $20,198.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.67 / $2,786.02 / $5,301.59
| Facility | | $2,207.67 | $2,786.02 | $5,301.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,515.94 / $3,499.45 / $4,117.00
| Professional | | $2,515.94 | $3,499.45 | $4,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,180.17 / $2,447.53 / $3,952.59
| Professional | | $2,180.17 | $2,447.53 | $3,952.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.67 / $2,816.40 / $5,970.03
| Facility | | $2,207.67 | $2,816.40 | $5,970.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,437.33 / $3,244.58 / $5,280.45
| Professional | | $2,437.33 | $3,244.58 | $5,280.45 |
- 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
- $1,957.30 / $2,707.79 / $4,244.97
| Professional | | $1,957.30 | $2,707.79 | $4,244.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,952.07 / $2,234.16 / $3,057.16
| Professional | | $1,952.07 | $2,234.16 | $3,057.16 |