- 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
- $1,968.33 / $2,207.23 / $3,255.71
| Professional | | $1,968.33 | $2,207.23 | $3,255.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,972.69 / $2,496.94 / $3,478.81
| Professional | | $1,972.69 | $2,496.94 | $3,478.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.48 / $1,947.48 / $2,026.67
| Facility | | $1,947.48 | $1,947.48 | $2,026.67 |
- 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
- $1,906.37 / $2,798.43 / $4,370.62
| Professional | | $1,906.37 | $2,798.43 | $4,370.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $19,270.88
| Facility | | $55.00 | $55.00 | $19,270.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,088.88 / $15,454.88 / $18,473.18
| Professional | | $15,088.88 | $15,454.88 | $18,473.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,013.00 / $2,452.15 / $4,390.34
| Facility | | $2,013.00 | $2,452.15 | $4,390.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,401.53 / $3,195.08 / $3,758.92
| Professional | | $2,401.53 | $3,195.08 | $3,758.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,838.10 / $5,400.20
| Professional | | $7.00 | $1,838.10 | $5,400.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.00 / $2,493.21 / $4,897.18
| Facility | | $2,015.00 | $2,493.21 | $4,897.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,034.82 / $2,980.72 / $5,338.56
| Professional | | $2,034.82 | $2,980.72 | $5,338.56 |
- 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
- $1,734.59 / $2,369.61 / $3,687.13
| Professional | | $1,734.59 | $2,369.61 | $3,687.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,782.29 / $2,070.62 / $2,792.65
| Professional | | $1,782.29 | $2,070.62 | $2,792.65 |