- 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
- $1,805.44 / $2,193.13 / $3,637.44
| Professional | | $1,805.44 | $2,193.13 | $3,637.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.88 / $2,521.94 / $3,537.39
| Professional | | $2,036.88 | $2,521.94 | $3,537.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,083.16 / $2,191.09
| Facility | | $80.00 | $2,083.16 | $2,191.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.87 / $2,528.87 / $2,528.87
| Facility | | $2,528.87 | $2,528.87 | $2,528.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,177.37 / $2,939.32 / $4,334.64
| Professional | | $2,177.37 | $2,939.32 | $4,334.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $38,289.28
| Facility | | $55.00 | $5,000.00 | $38,289.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,012.54 / $15,628.72 / $18,891.83
| Professional | | $15,012.54 | $15,628.72 | $18,891.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,999.36 / $2,478.48 / $4,067.99
| Facility | | $1,999.36 | $2,478.48 | $4,067.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,617.23 / $3,140.69 / $3,894.45
| Professional | | $2,617.23 | $3,140.69 | $3,894.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,258.60 / $2,258.60 / $2,258.60
| Professional | | $2,258.60 | $2,258.60 | $2,258.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.97 / $2,482.29 / $4,246.12
| Facility | | $2,005.97 | $2,482.29 | $4,246.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,229.53 / $3,027.47 / $4,461.06
| Professional | | $2,229.53 | $3,027.47 | $4,461.06 |
- 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
- $1,746.88 / $2,370.05 / $3,717.34
| Professional | | $1,746.88 | $2,370.05 | $3,717.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,786.99 / $2,030.74 / $2,787.20
| Professional | | $1,786.99 | $2,030.74 | $2,787.20 |