- 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
- $2,250.73 / $2,576.23 / $3,079.25
| Professional | | $2,250.73 | $2,576.23 | $3,079.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,334.19 / $3,897.98 / $11,792.58
| Facility | | $2,334.19 | $3,897.98 | $11,792.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,093.66 / $2,650.06 / $3,692.13
| Professional | | $2,093.66 | $2,650.06 | $3,692.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,700.49 / $3,249.23 / $4,541.58
| Professional | | $2,700.49 | $3,249.23 | $4,541.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.60 / $2,104.60 / $2,104.60
| Facility | | $2,104.60 | $2,104.60 | $2,104.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,361.92 / $3,101.10 / $4,879.24
| Professional | | $2,361.92 | $3,101.10 | $4,879.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $53,630.64
| Facility | | $55.00 | $55.00 | $53,630.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,137.00 / $22,658.53 / $22,658.53
| Professional | | $21,137.00 | $22,658.53 | $22,658.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,268.41 / $2,851.60 / $5,164.83
| Facility | | $2,268.41 | $2,851.60 | $5,164.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,872.88 / $3,314.87 / $3,867.34
| Professional | | $2,872.88 | $3,314.87 | $3,867.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,053.30 / $3,053.30 / $3,053.30
| Professional | | $3,053.30 | $3,053.30 | $3,053.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,272.84 / $2,880.72 / $5,836.80
| Facility | | $2,272.84 | $2,880.72 | $5,836.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,357.57 / $3,199.54 / $5,261.96
| Professional | | $2,357.57 | $3,199.54 | $5,261.96 |
- 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
- $1,950.57 / $2,558.05 / $4,095.10
| Professional | | $1,950.57 | $2,558.05 | $4,095.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,886.09 / $2,160.39 / $2,957.23
| Professional | | $1,886.09 | $2,160.39 | $2,957.23 |