- 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
- $2,105.35 / $2,385.35 / $3,578.40
| Professional | | $2,105.35 | $2,385.35 | $3,578.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.02 / $4,016.88 / $9,037.00
| Facility | | $2,400.02 | $4,016.88 | $9,037.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,251.25 / $2,849.53 / $3,970.04
| Professional | | $2,251.25 | $2,849.53 | $3,970.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.35 / $2,050.35 / $2,050.35
| Facility | | $2,050.35 | $2,050.35 | $2,050.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,552.25 / $3,389.24 / $5,119.00
| Professional | | $2,552.25 | $3,389.24 | $5,119.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $33,163.92
| Facility | | $55.00 | $55.00 | $33,163.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,559.75 / $18,098.00 / $20,348.48
| Professional | | $17,559.75 | $18,098.00 | $20,348.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.15 / $3,101.28 / $5,355.84
| Facility | | $2,320.15 | $3,101.28 | $5,355.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,596.00 / $3,610.80 / $4,248.00
| Professional | | $2,596.00 | $3,610.80 | $4,248.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,302.40 / $3,302.40 / $3,302.40
| Professional | | $3,302.40 | $3,302.40 | $3,302.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.64 / $3,177.90 / $5,530.66
| Facility | | $2,337.64 | $3,177.90 | $5,530.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.63 / $3,419.23 / $5,162.06
| Professional | | $2,578.63 | $3,419.23 | $5,162.06 |
- 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
- $2,023.62 / $2,778.97 / $4,300.18
| Professional | | $2,023.62 | $2,778.97 | $4,300.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,014.19 / $2,298.32 / $3,182.90
| Professional | | $2,014.19 | $2,298.32 | $3,182.90 |