- 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
- $1,784.19 / $2,167.10 / $3,448.52
| Professional | | $1,784.19 | $2,167.10 | $3,448.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.94 / $2,564.35 / $3,494.38
| Professional | | $2,025.94 | $2,564.35 | $3,494.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,059.17 / $2,165.35
| Facility | | $80.00 | $2,059.17 | $2,165.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,498.52 / $2,498.52 / $2,498.52
| Facility | | $2,498.52 | $2,498.52 | $2,498.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,170.71 / $2,913.19 / $4,295.39
| Professional | | $2,170.71 | $2,913.19 | $4,295.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $39,293.92
| Facility | | $55.00 | $5,000.00 | $39,293.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,219.06 / $15,444.48 / $19,629.75
| Professional | | $15,219.06 | $15,444.48 | $19,629.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.92 / $2,508.01 / $4,060.78
| Facility | | $1,995.92 | $2,508.01 | $4,060.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,697.30 / $3,236.76 / $4,013.58
| Professional | | $2,697.30 | $3,236.76 | $4,013.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,318.69 / $2,318.69 / $2,318.69
| Professional | | $2,318.69 | $2,318.69 | $2,318.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.23 / $2,515.29 / $4,227.07
| Facility | | $2,027.23 | $2,515.29 | $4,227.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,203.64 / $3,031.11 / $4,432.60
| Professional | | $2,203.64 | $3,031.11 | $4,432.60 |
- 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
- $1,725.01 / $2,289.46 / $3,650.27
| Professional | | $1,725.01 | $2,289.46 | $3,650.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,841.65 / $2,090.01 / $2,866.19
| Professional | | $1,841.65 | $2,090.01 | $2,866.19 |