- 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
- $1,891.11 / $2,299.46 / $3,655.88
| Professional | | $1,891.11 | $2,299.46 | $3,655.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.84 / $4,235.80 / $10,951.29
| Facility | | $2,460.84 | $4,235.80 | $10,951.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,149.67 / $2,720.97 / $3,707.81
| Professional | | $2,149.67 | $2,720.97 | $3,707.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,169.65 / $2,285.66
| Facility | | $80.00 | $2,169.65 | $2,285.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.88 / $2,651.88 / $2,651.88
| Facility | | $2,651.88 | $2,651.88 | $2,651.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,287.67 / $3,089.59 / $4,537.92
| Professional | | $2,287.67 | $3,089.59 | $4,537.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $23,413.77
| Facility | | $55.00 | $5,000.00 | $23,413.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,162.74 / $16,360.08 / $20,820.15
| Professional | | $16,162.74 | $16,360.08 | $20,820.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,115.26 / $2,625.72 / $4,219.91
| Facility | | $2,115.26 | $2,625.72 | $4,219.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,859.03 / $3,430.83 / $4,254.22
| Professional | | $2,859.03 | $3,430.83 | $4,254.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.50 / $2,448.50 / $2,448.50
| Professional | | $2,448.50 | $2,448.50 | $2,448.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.91 / $2,651.88 / $4,352.68
| Facility | | $2,116.91 | $2,651.88 | $4,352.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,324.34 / $3,219.26 / $4,683.00
| Professional | | $2,324.34 | $3,219.26 | $4,683.00 |
- 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
- $1,825.22 / $2,453.92 / $3,893.79
| Professional | | $1,825.22 | $2,453.92 | $3,893.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,952.07 / $2,216.19 / $3,036.88
| Professional | | $1,952.07 | $2,216.19 | $3,036.88 |