- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,611.29 / $10,893.00
| Facility | | $945.00 | $3,611.29 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,115.42 / $2,363.54 / $3,501.86
| Professional | | $2,115.42 | $2,363.54 | $3,501.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.91 / $2,603.69 / $3,689.21
| Professional | | $2,102.91 | $2,603.69 | $3,689.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,081.14 / $2,081.14 / $2,170.46
| Facility | | $2,081.14 | $2,081.14 | $2,170.46 |
- 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
- $2,129.13 / $3,003.35 / $4,708.72
| Professional | | $2,129.13 | $3,003.35 | $4,708.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $20,701.04
| Facility | | $55.00 | $55.00 | $20,701.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,210.16 / $16,589.28 / $19,860.00
| Professional | | $16,210.16 | $16,589.28 | $19,860.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,165.40 / $2,655.05 / $4,681.59
| Facility | | $2,165.40 | $2,655.05 | $4,681.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,581.19 / $3,434.12 / $4,040.14
| Professional | | $2,581.19 | $3,434.12 | $4,040.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,809.20 / $4,302.45 / $8,421.14
| Professional | | $1,809.20 | $4,302.45 | $8,421.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,165.40 / $2,666.61 / $5,259.28
| Facility | | $2,165.40 | $2,666.61 | $5,259.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,210.27 / $3,208.19 / $5,733.64
| Professional | | $2,210.27 | $3,208.19 | $5,733.64 |
- 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
- $1,839.60 / $2,544.81 / $3,984.71
| Professional | | $1,839.60 | $2,544.81 | $3,984.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.63 / $2,225.19 / $3,000.40
| Professional | | $1,915.63 | $2,225.19 | $3,000.40 |