- 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
- $1,561.87 / $1,894.62 / $3,086.48
| Professional | | $1,561.87 | $1,894.62 | $3,086.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,771.70 / $2,242.54 / $3,055.86
| Professional | | $1,771.70 | $2,242.54 | $3,055.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $1,813.47 / $1,903.35
| Facility | | $80.00 | $1,813.47 | $1,903.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,182.87 / $3,603.00 / $6,702.00
| Facility | | $2,182.87 | $3,603.00 | $6,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,909.66 / $2,546.19 / $3,835.58
| Professional | | $1,909.66 | $2,546.19 | $3,835.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $19,352.34
| Facility | | $55.00 | $5,000.00 | $19,352.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,275.30 / $13,522.32 / $17,164.28
| Professional | | $13,275.30 | $13,522.32 | $17,164.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.74 / $2,297.10 / $3,716.88
| Facility | | $1,803.74 | $2,297.10 | $3,716.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,360.09 / $2,832.11 / $3,511.81
| Professional | | $2,360.09 | $2,832.11 | $3,511.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.23 / $3,200.30 / $7,013.38
| Professional | | $2,147.23 | $3,200.30 | $7,013.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,816.89 / $2,312.73 / $3,894.86
| Facility | | $1,816.89 | $2,312.73 | $3,894.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,926.57 / $2,662.19 / $3,932.27
| Professional | | $1,926.57 | $2,662.19 | $3,932.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.00 / $2,064.00 / $8,759.00
| Facility | | $432.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,504.70 / $1,986.78 / $3,182.25
| Professional | | $1,504.70 | $1,986.78 | $3,182.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,611.41 / $1,827.91 / $2,508.91
| Professional | | $1,611.41 | $1,827.91 | $2,508.91 |