- 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
- $2,448.40 / $2,756.83 / $4,032.99
| Professional | | $2,448.40 | $2,756.83 | $4,032.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,471.94 / $3,140.92 / $4,359.22
| Professional | | $2,471.94 | $3,140.92 | $4,359.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,449.23 / $2,449.23 / $2,548.58
| Facility | | $2,449.23 | $2,449.23 | $2,548.58 |
- 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
- $2,558.50 / $3,480.68 / $5,417.50
| Professional | | $2,558.50 | $3,480.68 | $5,417.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $48,477.92
| Facility | | $55.00 | $55.00 | $48,477.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,979.04 / $19,403.20 / $23,233.50
| Professional | | $18,979.04 | $19,403.20 | $23,233.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,549.01 / $3,152.05 / $5,508.32
| Facility | | $2,549.01 | $3,152.05 | $5,508.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,020.52 / $4,018.61 / $4,727.77
| Professional | | $3,020.52 | $4,018.61 | $4,727.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $3,367.50 / $6,748.70
| Professional | | $15.00 | $3,367.50 | $6,748.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,549.01 / $3,199.00 / $6,125.00
| Facility | | $2,549.01 | $3,199.00 | $6,125.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,638.16 / $3,721.85 / $6,690.81
| Professional | | $2,638.16 | $3,721.85 | $6,690.81 |
- 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
- $2,173.15 / $2,956.77 / $4,639.37
| Professional | | $2,173.15 | $2,956.77 | $4,639.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,241.67 / $2,604.35 / $3,512.55
| Professional | | $2,241.67 | $2,604.35 | $3,512.55 |