- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $12,941.00
| Facility | | $969.00 | $3,682.00 | $12,941.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,263.67 / $2,526.42 / $3,745.49
| Professional | | $2,263.67 | $2,526.42 | $3,745.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.90 / $2,450.69 / $3,904.77
| Professional | | $560.90 | $2,450.69 | $3,904.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.67 / $2,232.67 / $2,325.71
| Facility | | $2,232.67 | $2,232.67 | $2,325.71 |
- 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
- $2,288.96 / $3,206.75 / $5,038.35
| Professional | | $2,288.96 | $3,206.75 | $5,038.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $22,157.84
| Facility | | $55.00 | $55.00 | $22,157.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,349.59 / $17,744.64 / $21,248.63
| Professional | | $17,349.59 | $17,744.64 | $21,248.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.42 / $2,779.19 / $5,017.83
| Facility | | $2,243.42 | $2,779.19 | $5,017.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,761.99 / $3,674.65 / $4,323.10
| Professional | | $2,761.99 | $3,674.65 | $4,323.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,451.92 / $4,294.30 / $8,965.76
| Professional | | $2,451.92 | $4,294.30 | $8,965.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,261.66 / $2,809.12 / $5,612.77
| Facility | | $2,261.66 | $2,809.12 | $5,612.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,362.13 / $3,425.13 / $6,130.38
| Professional | | $2,362.13 | $3,425.13 | $6,130.38 |
- 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
- $1,955.66 / $2,690.51 / $4,244.72
| Professional | | $1,955.66 | $2,690.51 | $4,244.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.80 / $2,381.23 / $3,211.27
| Professional | | $2,049.80 | $2,381.23 | $3,211.27 |