- 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
- $2,154.66 / $2,432.54 / $3,568.95
| Professional | | $2,154.66 | $2,432.54 | $3,568.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,429.31 / $4,246.08 / $21,245.63
| Facility | | $2,429.31 | $4,246.08 | $21,245.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,362.37 / $2,990.18 / $4,109.20
| Professional | | $2,362.37 | $2,990.18 | $4,109.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,546.25 / $2,546.25 / $2,546.25
| Facility | | $2,546.25 | $2,546.25 | $2,546.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,548.26 / $3,271.91 / $4,882.22
| Professional | | $2,548.26 | $3,271.91 | $4,882.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $34,027.19
| Facility | | $55.00 | $55.00 | $34,027.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,496.64 / $18,091.28 / $22,273.95
| Professional | | $17,496.64 | $18,091.28 | $22,273.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,195.58 / $2,807.97 / $5,447.81
| Facility | | $2,195.58 | $2,807.97 | $5,447.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,717.33 / $3,779.56 / $4,446.54
| Professional | | $2,717.33 | $3,779.56 | $4,446.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,426.30 / $2,426.30 / $2,426.30
| Professional | | $2,426.30 | $2,426.30 | $2,426.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.88 / $2,830.74 / $5,586.95
| Facility | | $2,206.88 | $2,830.74 | $5,586.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,592.03 / $3,349.45 / $5,131.54
| Professional | | $2,592.03 | $3,349.45 | $5,131.54 |
- 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
- $1,928.00 / $2,699.19 / $4,317.55
| Professional | | $1,928.00 | $2,699.19 | $4,317.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,108.33 / $2,379.30 / $3,298.85
| Professional | | $2,108.33 | $2,379.30 | $3,298.85 |