- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $12,281.00
| Facility | | $969.00 | $3,682.00 | $12,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,860.88 / $2,074.08 / $3,495.44
| Professional | | $1,860.88 | $2,074.08 | $3,495.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.24 / $2,909.02 / $5,053.03
| Professional | | $1,897.24 | $2,909.02 | $5,053.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,798.97 / $1,846.66
| Facility | | $80.00 | $1,798.97 | $1,846.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.54 / $2,326.54 / $2,326.54
| Facility | | $2,326.54 | $2,326.54 | $2,326.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,083.38 / $2,843.02 / $4,379.93
| Professional | | $2,083.38 | $2,843.02 | $4,379.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,353.82
| Facility | | $55.00 | $55.00 | $16,353.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,172.06 / $18,246.50 / $18,848.64
| Professional | | $18,172.06 | $18,246.50 | $18,848.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,997.89 / $2,881.19 / $4,550.18
| Facility | | $1,997.89 | $2,881.19 | $4,550.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.90 / $3,013.08 / $3,736.22
| Professional | | $2,510.90 | $3,013.08 | $3,736.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,255.70 / $3,255.70 / $3,255.70
| Professional | | $3,255.70 | $3,255.70 | $3,255.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,997.89 / $2,916.66 / $4,558.67
| Facility | | $1,997.89 | $2,916.66 | $4,558.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,105.79 / $2,951.59 / $4,405.32
| Professional | | $2,105.79 | $2,951.59 | $4,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,123.00 / $16,000.00
| Facility | | $2,600.00 | $7,123.00 | $16,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,652.69 / $2,240.48 / $3,617.47
| Professional | | $1,652.69 | $2,240.48 | $3,617.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,714.38 / $1,952.76 / $2,699.33
| Professional | | $1,714.38 | $1,952.76 | $2,699.33 |