- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $12,040.00
| Facility | | $969.00 | $3,682.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,556.09 / $2,874.20 / $4,233.82
| Professional | | $2,556.09 | $2,874.20 | $4,233.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,512.85 / $3,064.42 / $4,461.82
| Professional | | $2,512.85 | $3,064.42 | $4,461.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,359.40 / $2,359.40 / $2,381.23
| Facility | | $2,359.40 | $2,359.40 | $2,381.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,619.00
| Facility | | $900.00 | $2,277.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,494.25 / $3,562.01 / $5,685.19
| Professional | | $2,494.25 | $3,562.01 | $5,685.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $34,123.32
| Facility | | $55.00 | $55.00 | $34,123.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,662.40 / $20,261.75 / $22,860.83
| Professional | | $19,662.40 | $20,261.75 | $22,860.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,536.41 / $3,191.12 / $5,869.37
| Facility | | $2,536.41 | $3,191.12 | $5,869.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,042.83 / $4,048.29 / $4,762.68
| Professional | | $3,042.83 | $4,048.29 | $4,762.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $3,138.90 / $7,085.60
| Professional | | $7.00 | $3,138.90 | $7,085.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,533.60 / $3,191.12 / $6,242.31
| Facility | | $2,533.60 | $3,191.12 | $6,242.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,601.92 / $3,791.45 / $6,791.21
| Professional | | $2,601.92 | $3,791.45 | $6,791.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,279.13 / $2,991.36 / $4,784.89
| Professional | | $2,279.13 | $2,991.36 | $4,784.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,258.23 / $2,639.58 / $3,572.55
| Professional | | $2,258.23 | $2,639.58 | $3,572.55 |