- 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
- $1,796.74 / $2,041.82 / $2,995.70
| Professional | | $1,796.74 | $2,041.82 | $2,995.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.87 / $2,316.17 / $3,226.95
| Professional | | $1,829.87 | $2,316.17 | $3,226.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.77 / $1,857.77 / $1,917.04
| Facility | | $1,857.77 | $1,857.77 | $1,917.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,256.13 / $4,619.00
| Facility | | $900.00 | $2,256.13 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,780.00 / $2,519.81 / $3,853.34
| Professional | | $1,780.00 | $2,519.81 | $3,853.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $18,017.36
| Facility | | $55.00 | $55.00 | $18,017.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,104.32 / $14,396.16 / $17,210.63
| Professional | | $14,104.32 | $14,396.16 | $17,210.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.39 / $2,155.92 / $4,011.88
| Facility | | $1,786.39 | $2,155.92 | $4,011.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.10 / $2,980.30 / $3,506.24
| Professional | | $2,240.10 | $2,980.30 | $3,506.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.50 / $2,297.15 / $5,042.00
| Professional | | $1,554.50 | $2,297.15 | $5,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,801.69 / $2,170.44 / $4,403.05
| Facility | | $1,801.69 | $2,170.44 | $4,403.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,876.78 / $2,661.98 / $4,889.03
| Professional | | $1,876.78 | $2,661.98 | $4,889.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $2,502.00 / $9,000.00
| Facility | | $471.00 | $2,502.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,542.02 / $2,074.42 / $3,277.60
| Professional | | $1,542.02 | $2,074.42 | $3,277.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,662.48 / $1,932.68 / $2,609.16
| Professional | | $1,662.48 | $1,932.68 | $2,609.16 |