- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,682.00 / $10,893.00
| Facility | | $945.00 | $3,682.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,580.67 / $2,917.36 / $4,410.50
| Professional | | $2,580.67 | $2,917.36 | $4,410.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,568.19 / $3,273.03 / $4,560.06
| Professional | | $2,568.19 | $3,273.03 | $4,560.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,620.80 / $2,620.80 / $2,728.65
| Facility | | $2,620.80 | $2,620.80 | $2,728.65 |
- 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
- $2,406.86 / $3,732.05 / $5,808.88
| Professional | | $2,406.86 | $3,732.05 | $5,808.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $50,487.52
| Facility | | $55.00 | $55.00 | $50,487.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,801.12 / $20,305.84 / $24,164.93
| Professional | | $19,801.12 | $20,305.84 | $24,164.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.67 / $3,107.15 / $5,970.31
| Facility | | $2,385.67 | $3,107.15 | $5,970.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,146.99 / $4,186.85 / $4,925.72
| Professional | | $3,146.99 | $4,186.85 | $4,925.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,596.42 / $3,040.70 / $5,522.50
| Professional | | $2,596.42 | $3,040.70 | $5,522.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.08 / $3,134.39 / $6,483.49
| Facility | | $2,386.08 | $3,134.39 | $6,483.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,673.03 / $3,946.76 / $7,004.37
| Professional | | $2,673.03 | $3,946.76 | $7,004.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $2,546.00 / $9,000.00
| Facility | | $471.00 | $2,546.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,301.21 / $3,117.82 / $4,886.33
| Professional | | $2,301.21 | $3,117.82 | $4,886.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.53 / $2,713.63 / $3,657.78
| Professional | | $2,335.53 | $2,713.63 | $3,657.78 |