- 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
- $1,999.96 / $2,277.52 / $3,560.88
| Professional | | $1,999.96 | $2,277.52 | $3,560.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,004.09 / $2,537.34 / $3,534.17
| Professional | | $2,004.09 | $2,537.34 | $3,534.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.15 / $1,993.15 / $2,068.21
| Facility | | $1,993.15 | $1,993.15 | $2,068.21 |
- 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
- $2,071.42 / $2,900.06 / $4,482.14
| Professional | | $2,071.42 | $2,900.06 | $4,482.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $19,594.00
| Facility | | $55.00 | $55.00 | $19,594.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,956.93 / $17,956.93 / $18,760.43
| Professional | | $17,956.93 | $17,956.93 | $18,760.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.14 / $2,581.48 / $4,866.10
| Facility | | $2,075.14 | $2,581.48 | $4,866.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,439.85 / $3,246.06 / $3,818.90
| Professional | | $2,439.85 | $3,246.06 | $3,818.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,244.86 / $3,642.57 / $7,878.09
| Professional | | $2,244.86 | $3,642.57 | $7,878.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.14 / $2,601.84 / $4,980.87
| Facility | | $2,075.14 | $2,601.84 | $4,980.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,168.19 / $3,041.18 / $5,440.39
| Professional | | $2,168.19 | $3,041.18 | $5,440.39 |
- 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
- $1,785.41 / $2,410.10 / $3,736.60
| Professional | | $1,785.41 | $2,410.10 | $3,736.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,810.73 / $2,104.12 / $2,838.79
| Professional | | $1,810.73 | $2,104.12 | $2,838.79 |