- 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
- $2,781.40 / $3,188.37 / $3,811.15
| Professional | | $2,781.40 | $3,188.37 | $3,811.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,688.28 / $2,688.28 / $2,688.28
| Professional | | $2,688.28 | $2,688.28 | $2,688.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,600.29 / $3,291.34 / $4,585.57
| Professional | | $2,600.29 | $3,291.34 | $4,585.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,622.44 / $5,434.00 / $5,434.00
| Facility | | $2,622.44 | $5,434.00 | $5,434.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,933.09 / $3,783.46 / $5,974.56
| Professional | | $2,933.09 | $3,783.46 | $5,974.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $66,566.64
| Facility | | $55.00 | $55.00 | $66,566.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,251.92 / $23,142.00 / $24,295.13
| Professional | | $22,251.92 | $23,142.00 | $24,295.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,822.69 / $3,474.03 / $6,356.71
| Facility | | $2,822.69 | $3,474.03 | $6,356.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,575.55 / $4,125.63 / $4,813.24
| Professional | | $3,575.55 | $4,125.63 | $4,813.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,610.33 / $2,946.83 / $4,753.43
| Professional | | $2,610.33 | $2,946.83 | $4,753.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,822.69 / $3,494.76 / $7,249.23
| Facility | | $2,822.69 | $3,494.76 | $7,249.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,946.83 / $3,838.15 / $6,501.91
| Professional | | $2,946.83 | $3,838.15 | $6,501.91 |
- 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
- $2,383.17 / $3,148.37 / $4,951.62
| Professional | | $2,383.17 | $3,148.37 | $4,951.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,347.40 / $2,688.28 / $3,675.04
| Professional | | $2,347.40 | $2,688.28 | $3,675.04 |