- 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
- $2,665.41 / $3,050.26 / $3,643.00
| Professional | | $2,665.41 | $3,050.26 | $3,643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,482.71 / $3,142.51 / $4,378.22
| Professional | | $2,482.71 | $3,142.51 | $4,378.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,205.73 / $3,857.13 / $5,388.22
| Professional | | $3,205.73 | $3,857.13 | $5,388.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.19 / $2,520.19 / $2,520.19
| Facility | | $2,520.19 | $2,520.19 | $2,520.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,808.31 / $3,650.36 / $5,672.36
| Professional | | $2,808.31 | $3,650.36 | $5,672.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $78,767.78
| Facility | | $55.00 | $55.00 | $78,767.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,188.00 / $28,429.64 / $28,429.64
| Professional | | $27,188.00 | $28,429.64 | $28,429.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.87 / $3,473.17 / $6,064.09
| Facility | | $2,757.87 | $3,473.17 | $6,064.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,414.50 / $3,939.81 / $4,596.45
| Professional | | $3,414.50 | $3,939.81 | $4,596.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,129.60 / $4,129.60 / $4,129.60
| Professional | | $4,129.60 | $4,129.60 | $4,129.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.87 / $3,629.26 / $6,920.58
| Facility | | $2,757.87 | $3,629.26 | $6,920.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,808.31 / $3,778.89 / $5,966.73
| Professional | | $2,808.31 | $3,778.89 | $5,966.73 |
- 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
- $2,286.61 / $3,004.24 / $4,790.88
| Professional | | $2,286.61 | $3,004.24 | $4,790.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,241.67 / $2,564.58 / $3,511.50
| Professional | | $2,241.67 | $2,564.58 | $3,511.50 |