- 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
- $2,413.28 / $2,939.23 / $4,887.55
| Professional | | $2,413.28 | $2,939.23 | $4,887.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,347.96 / $3,176.58 / $4,628.28
| Professional | | $2,347.96 | $3,176.58 | $4,628.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,748.59 / $2,903.32
| Facility | | $80.00 | $2,748.59 | $2,903.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,393.22 / $3,603.00 / $6,702.00
| Facility | | $3,393.22 | $3,603.00 | $6,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,961.61 / $3,960.47 / $5,892.70
| Professional | | $2,961.61 | $3,960.47 | $5,892.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $46,484.62
| Facility | | $55.00 | $5,000.00 | $46,484.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,716.25 / $20,873.84 / $26,622.68
| Professional | | $20,716.25 | $20,873.84 | $26,622.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.79 / $3,465.44 / $5,687.31
| Facility | | $2,764.79 | $3,465.44 | $5,687.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,652.33 / $4,382.79 / $5,434.66
| Professional | | $3,652.33 | $4,382.79 | $5,434.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,257.67 / $4,946.84 / $10,831.52
| Professional | | $3,257.67 | $4,946.84 | $10,831.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,787.77 / $3,465.44 / $5,719.62
| Facility | | $2,787.77 | $3,465.44 | $5,719.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,013.40 / $4,138.26 / $6,065.45
| Professional | | $3,013.40 | $4,138.26 | $6,065.45 |
- 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
- $2,347.36 / $3,103.34 / $4,903.28
| Professional | | $2,347.36 | $3,103.34 | $4,903.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.71 / $2,832.76 / $3,877.32
| Professional | | $2,493.71 | $2,832.76 | $3,877.32 |