- 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
- $1,882.01 / $2,242.06 / $3,535.10
| Professional | | $1,882.01 | $2,242.06 | $3,535.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.38 / $3,012.58 / $5,039.57
| Professional | | $2,076.38 | $3,012.58 | $5,039.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,970.65 / $2,000.38
| Facility | | $80.00 | $1,970.65 | $2,000.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,513.88 / $2,513.88 / $2,513.88
| Facility | | $2,513.88 | $2,513.88 | $2,513.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,040.73 / $2,853.36 / $4,222.01
| Professional | | $2,040.73 | $2,853.36 | $4,222.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $20,420.48
| Facility | | $55.00 | $55.00 | $20,420.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,626.21 / $24,626.21 / $24,626.21
| Professional | | $24,626.21 | $24,626.21 | $24,626.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.90 / $2,492.87 / $4,498.34
| Facility | | $1,950.90 | $2,492.87 | $4,498.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,732.48 / $3,278.97 / $4,065.92
| Professional | | $2,732.48 | $3,278.97 | $4,065.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,327.60 / $2,327.60 / $2,327.60
| Professional | | $2,327.60 | $2,327.60 | $2,327.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,954.47 / $2,505.69 / $5,019.25
| Facility | | $1,954.47 | $2,505.69 | $5,019.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,112.59 / $2,978.56 / $4,534.68
| Professional | | $2,112.59 | $2,978.56 | $4,534.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.83 / $2,255.88 / $3,607.89
| Professional | | $1,669.83 | $2,255.88 | $3,607.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,865.67 / $2,118.90 / $2,945.01
| Professional | | $1,865.67 | $2,118.90 | $2,945.01 |