- 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
- $2,251.88 / $2,669.56 / $4,324.96
| Professional | | $2,251.88 | $2,669.56 | $4,324.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.82 / $4,497.97 / $12,537.99
| Facility | | $2,748.82 | $4,497.97 | $12,537.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.85 / $3,113.29 / $4,337.52
| Professional | | $2,442.85 | $3,113.29 | $4,337.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,428.67 / $2,428.67 / $2,428.67
| Facility | | $2,428.67 | $2,428.67 | $2,428.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,863.90 / $3,909.96 / $5,831.86
| Professional | | $2,863.90 | $3,909.96 | $5,831.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $40,778.04
| Facility | | $55.00 | $55.00 | $40,778.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,905.28 / $21,487.76 / $27,062.63
| Professional | | $20,905.28 | $21,487.76 | $27,062.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,667.94 / $3,609.40 / $5,946.43
| Facility | | $2,667.94 | $3,609.40 | $5,946.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,278.45 / $4,560.03 / $5,364.74
| Professional | | $3,278.45 | $4,560.03 | $5,364.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,385.00 / $3,385.00 / $3,385.00
| Professional | | $3,385.00 | $3,385.00 | $3,385.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,673.41 / $3,629.53 / $6,288.89
| Facility | | $2,673.41 | $3,629.53 | $6,288.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,866.94 / $3,867.50 / $6,051.27
| Professional | | $2,866.94 | $3,867.50 | $6,051.27 |
- 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
- $2,232.07 / $3,069.10 / $4,743.14
| Professional | | $2,232.07 | $3,069.10 | $4,743.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,543.69 / $2,883.31 / $3,963.26
| Professional | | $2,543.69 | $2,883.31 | $3,963.26 |