- 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
- $1,965.31 / $2,390.23 / $3,802.90
| Professional | | $1,965.31 | $2,390.23 | $3,802.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,319.98 / $2,838.60 / $3,939.64
| Professional | | $2,319.98 | $2,838.60 | $3,939.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,253.62 / $2,374.76
| Facility | | $80.00 | $2,253.62 | $2,374.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,756.33 / $2,756.33 / $2,756.33
| Facility | | $2,756.33 | $2,756.33 | $2,756.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,343.87 / $3,213.07 / $4,668.78
| Professional | | $2,343.87 | $3,213.07 | $4,668.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $24,334.47
| Facility | | $55.00 | $5,000.00 | $24,334.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,614.56 / $16,999.52 / $21,644.93
| Professional | | $16,614.56 | $16,999.52 | $21,644.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,177.79 / $2,711.59 / $4,480.42
| Facility | | $2,177.79 | $2,711.59 | $4,480.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,971.84 / $3,566.21 / $4,422.09
| Professional | | $2,971.84 | $3,566.21 | $4,422.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,579.60 / $2,579.60 / $2,579.60
| Professional | | $2,579.60 | $2,579.60 | $2,579.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,177.79 / $2,713.37 / $4,586.27
| Facility | | $2,177.79 | $2,713.37 | $4,586.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,346.92 / $3,344.09 / $4,868.70
| Professional | | $2,346.92 | $3,344.09 | $4,868.70 |
- 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
- $1,883.33 / $2,541.21 / $4,075.85
| Professional | | $1,883.33 | $2,541.21 | $4,075.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.10 / $2,303.78 / $3,156.46
| Professional | | $2,029.10 | $2,303.78 | $3,156.46 |