- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,570.00 / $10,893.00
| Facility | | $945.00 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,050.32 / $2,302.28 / $3,524.20
| Professional | | $2,050.32 | $2,302.28 | $3,524.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,989.25 / $2,571.98 / $3,594.42
| Professional | | $1,989.25 | $2,571.98 | $3,594.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.17 / $2,075.17 / $2,158.29
| Facility | | $2,075.17 | $2,075.17 | $2,158.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,619.00
| Facility | | $900.00 | $2,277.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,163.40 / $2,993.00 / $4,579.89
| Professional | | $2,163.40 | $2,993.00 | $4,579.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $39,835.83
| Facility | | $55.00 | $55.00 | $39,835.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,623.44 / $16,020.08 / $19,056.90
| Professional | | $15,623.44 | $16,020.08 | $19,056.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,127.21 / $2,696.58 / $4,912.24
| Facility | | $2,127.21 | $2,696.58 | $4,912.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,482.25 / $3,302.47 / $3,885.26
| Professional | | $2,482.25 | $3,302.47 | $3,885.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $2,950.70 / $5,531.40
| Professional | | $15.00 | $2,950.70 | $5,531.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,127.21 / $2,719.12 / $5,113.82
| Facility | | $2,127.21 | $2,719.12 | $5,113.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,262.46 / $3,129.31 / $5,547.93
| Professional | | $2,262.46 | $3,129.31 | $5,547.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,881.19 / $2,474.42 / $3,941.34
| Professional | | $1,881.19 | $2,474.42 | $3,941.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.20 / $2,140.63 / $2,885.77
| Professional | | $1,842.20 | $2,140.63 | $2,885.77 |