- 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
- $1,920.92 / $2,334.57 / $3,879.26
| Professional | | $1,920.92 | $2,334.57 | $3,879.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.57 / $2,773.68 / $3,849.54
| Professional | | $2,271.57 | $2,773.68 | $3,849.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,210.71 / $2,327.11
| Facility | | $80.00 | $2,210.71 | $2,327.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,692.04 / $2,692.04 / $2,692.04
| Facility | | $2,692.04 | $2,692.04 | $2,692.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.84 / $3,139.47 / $4,664.54
| Professional | | $2,323.84 | $3,139.47 | $4,664.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $29,083.01
| Facility | | $55.00 | $5,000.00 | $29,083.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,414.74 / $16,623.59 / $21,145.50
| Professional | | $16,414.74 | $16,623.59 | $21,145.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,149.67 / $2,701.49 / $4,432.14
| Facility | | $2,149.67 | $2,701.49 | $4,432.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,904.71 / $3,485.66 / $4,322.21
| Professional | | $2,904.71 | $3,485.66 | $4,322.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,412.90 / $2,412.90 / $2,412.90
| Professional | | $2,412.90 | $2,412.90 | $2,412.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,154.50 / $2,726.94 / $4,484.97
| Facility | | $2,154.50 | $2,726.94 | $4,484.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,382.04 / $3,265.18 / $4,799.71
| Professional | | $2,382.04 | $3,265.18 | $4,799.71 |
- 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
- $1,872.32 / $2,516.38 / $4,006.19
| Professional | | $1,872.32 | $2,516.38 | $4,006.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,983.27 / $2,251.23 / $3,086.01
| Professional | | $1,983.27 | $2,251.23 | $3,086.01 |