- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $12,281.00
| Facility | | $969.00 | $3,682.00 | $12,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,111.15 / $2,370.41 / $3,494.08
| Professional | | $2,111.15 | $2,370.41 | $3,494.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,989.01 / $2,560.39 / $3,727.95
| Professional | | $1,989.01 | $2,560.39 | $3,727.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,079.77 / $2,079.77 / $2,167.67
| Facility | | $2,079.77 | $2,079.77 | $2,167.67 |
- 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
- $1,973.22 / $2,998.60 / $4,719.64
| Professional | | $1,973.22 | $2,998.60 | $4,719.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $20,661.43
| Facility | | $55.00 | $55.00 | $20,661.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,177.76 / $16,558.32 / $19,820.48
| Professional | | $16,177.76 | $16,558.32 | $19,820.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,181.04 / $2,720.25 / $4,705.67
| Facility | | $2,181.04 | $2,720.25 | $4,705.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,576.00 / $3,427.20 / $4,032.00
| Professional | | $2,576.00 | $3,427.20 | $4,032.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,670.80 / $5,771.90
| Professional | | $7.00 | $1,670.80 | $5,771.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,181.04 / $2,737.24 / $5,251.47
| Facility | | $2,181.04 | $2,737.24 | $5,251.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,183.80 / $3,206.86 / $5,722.02
| Professional | | $2,183.80 | $3,206.86 | $5,722.02 |
- 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
- $1,849.75 / $2,541.03 / $3,978.46
| Professional | | $1,849.75 | $2,541.03 | $3,978.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.77 / $2,220.75 / $2,994.58
| Professional | | $1,911.77 | $2,220.75 | $2,994.58 |