- 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
- $2,586.30 / $2,965.05 / $4,343.46
| Professional | | $2,586.30 | $2,965.05 | $4,343.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.00 / $1,283.50 / $3,686.38
| Professional | | $755.00 | $1,283.50 | $3,686.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,644.82 / $2,644.82 / $2,748.58
| Facility | | $2,644.82 | $2,644.82 | $2,748.58 |
- 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
- $2,732.38 / $3,718.63 / $5,835.68
| Professional | | $2,732.38 | $3,718.63 | $5,835.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $52,216.48
| Facility | | $55.00 | $55.00 | $52,216.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,442.24 / $20,891.91 / $25,011.08
| Professional | | $20,442.24 | $20,891.91 | $25,011.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.21 / $3,348.81 / $5,933.38
| Facility | | $2,735.21 | $3,348.81 | $5,933.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,252.26 / $4,326.92 / $5,090.49
| Professional | | $3,252.26 | $4,326.92 | $5,090.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $4,062.30 / $7,267.50
| Professional | | $15.00 | $4,062.30 | $7,267.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,743.31 / $3,383.71 / $6,203.21
| Facility | | $2,743.31 | $3,383.71 | $6,203.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,799.04 / $3,993.76 / $6,986.48
| Professional | | $2,799.04 | $3,993.76 | $6,986.48 |
- 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
- $2,284.90 / $3,030.14 / $4,784.17
| Professional | | $2,284.90 | $3,030.14 | $4,784.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,413.66 / $2,804.45 / $3,783.01
| Professional | | $2,413.66 | $2,804.45 | $3,783.01 |