- 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
- $2,264.76 / $2,512.59 / $3,696.22
| Professional | | $2,264.76 | $2,512.59 | $3,696.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,459.94 / $4,091.70 / $9,244.19
| Facility | | $2,459.94 | $4,091.70 | $9,244.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.21 / $2,967.19 / $3,380.74
| Professional | | $2,344.21 | $2,967.19 | $3,380.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,183.92 / $2,183.92 / $2,183.92
| Facility | | $2,183.92 | $2,183.92 | $2,183.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,546.02 / $3,347.92 / $5,137.64
| Professional | | $2,546.02 | $3,347.92 | $5,137.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $17,286.18
| Facility | | $55.00 | $55.00 | $17,286.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,267.04 / $18,800.00 / $21,228.08
| Professional | | $18,267.04 | $18,800.00 | $21,228.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,413.08 / $3,187.31 / $5,489.55
| Facility | | $2,413.08 | $3,187.31 | $5,489.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,703.46 / $3,760.27 / $4,423.84
| Professional | | $2,703.46 | $3,760.27 | $4,423.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,053.90 / $3,053.90 / $3,053.90
| Professional | | $3,053.90 | $3,053.90 | $3,053.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,413.08 / $3,208.07 / $5,619.02
| Facility | | $2,413.08 | $3,208.07 | $5,619.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,575.42 / $3,408.58 / $5,350.65
| Professional | | $2,575.42 | $3,408.58 | $5,350.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,547.00 / $9,000.00
| Facility | | $495.00 | $2,547.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,066.92 / $2,842.02 / $4,392.21
| Professional | | $2,066.92 | $2,842.02 | $4,392.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.56 / $2,384.66 / $3,317.92
| Professional | | $2,097.56 | $2,384.66 | $3,317.92 |