- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,646.35 / $10,836.00
| Facility | | $969.00 | $3,646.35 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,885.02 / $2,229.84 / $3,425.36
| Professional | | $1,885.02 | $2,229.84 | $3,425.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,317.87 / $3,865.04 / $9,037.00
| Facility | | $2,317.87 | $3,865.04 | $9,037.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,896.26 / $2,522.03 / $3,780.60
| Professional | | $1,896.26 | $2,522.03 | $3,780.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.46 / $2,163.46 / $2,163.46
| Facility | | $2,163.46 | $2,163.46 | $2,163.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,438.61 / $3,204.36 / $4,661.60
| Professional | | $2,438.61 | $3,204.36 | $4,661.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $31,129.92
| Facility | | $55.00 | $55.00 | $31,129.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,113.66 / $16,313.36 / $20,761.50
| Professional | | $16,113.66 | $16,313.36 | $20,761.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,197.69 / $2,915.78 / $5,197.68
| Facility | | $2,197.69 | $2,915.78 | $5,197.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,508.83 / $3,489.55 / $4,105.35
| Professional | | $2,508.83 | $3,489.55 | $4,105.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,021.70 / $3,021.70 / $3,021.70
| Professional | | $3,021.70 | $3,021.70 | $3,021.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,197.69 / $2,916.13 / $5,320.28
| Facility | | $2,197.69 | $2,916.13 | $5,320.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,451.03 / $3,204.36 / $4,776.14
| Professional | | $2,451.03 | $3,204.36 | $4,776.14 |
- 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
- $1,894.20 / $2,543.64 / $4,091.59
| Professional | | $1,894.20 | $2,543.64 | $4,091.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,946.55 / $2,209.91 / $3,028.29
| Professional | | $1,946.55 | $2,209.91 | $3,028.29 |