- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,618.63 / $10,836.00
| Facility | | $969.00 | $3,618.63 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,274.19 / $2,606.46 / $3,835.71
| Professional | | $2,274.19 | $2,606.46 | $3,835.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,363.01 / $3,913.74 / $9,060.27
| Facility | | $2,363.01 | $3,913.74 | $9,060.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,121.96 / $2,685.90 / $3,742.06
| Professional | | $2,121.96 | $2,685.90 | $3,742.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.89 / $2,143.89 / $2,143.89
| Facility | | $2,143.89 | $2,143.89 | $2,143.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,403.38 / $3,132.03 / $4,900.39
| Professional | | $2,403.38 | $3,132.03 | $4,900.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $67,260.44
| Facility | | $55.00 | $55.00 | $67,260.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,568.00 / $27,409.13 / $27,409.13
| Professional | | $25,568.00 | $27,409.13 | $27,409.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.38 / $2,966.92 / $6,057.60
| Facility | | $2,403.38 | $2,966.92 | $6,057.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,917.46 / $3,366.30 / $3,927.35
| Professional | | $2,917.46 | $3,366.30 | $3,927.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,444.10 / $3,444.10 / $3,444.10
| Professional | | $3,444.10 | $3,444.10 | $3,444.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.38 / $3,117.53 / $6,187.50
| Facility | | $2,403.38 | $3,117.53 | $6,187.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,403.38 / $3,244.25 / $5,009.30
| Professional | | $2,403.38 | $3,244.25 | $5,009.30 |
- 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
- $1,965.01 / $2,596.79 / $4,141.84
| Professional | | $1,965.01 | $2,596.79 | $4,141.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.36 / $2,193.11 / $2,999.03
| Professional | | $1,915.36 | $2,193.11 | $2,999.03 |