- 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
- $1,965.91 / $2,226.67 / $3,227.52
| Professional | | $1,965.91 | $2,226.67 | $3,227.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.58 / $3,213.27 / $8,920.75
| Facility | | $1,886.58 | $3,213.27 | $8,920.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,981.55 / $2,525.39 / $3,518.43
| Professional | | $1,981.55 | $2,525.39 | $3,518.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,019.23 / $2,019.23 / $2,086.13
| Facility | | $2,019.23 | $2,019.23 | $2,086.13 |
- 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
- $1,946.72 / $2,754.43 / $4,278.45
| Professional | | $1,946.72 | $2,754.43 | $4,278.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $19,634.96
| Facility | | $55.00 | $55.00 | $19,634.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,370.48 / $15,693.04 / $18,766.88
| Professional | | $15,370.48 | $15,693.04 | $18,766.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,999.53 / $2,430.46 / $4,398.13
| Facility | | $1,999.53 | $2,430.46 | $4,398.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.08 / $3,249.03 / $3,822.39
| Professional | | $2,442.08 | $3,249.03 | $3,822.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,495.66 / $5,491.90
| Professional | | $1,644.00 | $2,495.66 | $5,491.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.56 / $2,440.78 / $4,875.28
| Facility | | $2,001.56 | $2,440.78 | $4,875.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.60 / $2,973.53 / $5,333.64
| Professional | | $2,058.60 | $2,973.53 | $5,333.64 |
- 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
- $1,698.74 / $2,321.91 / $3,623.97
| Professional | | $1,698.74 | $2,321.91 | $3,623.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,812.39 / $2,106.73 / $2,843.73
| Professional | | $1,812.39 | $2,106.73 | $2,843.73 |