- 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
- $2,468.13 / $3,005.03 / $4,964.72
| Professional | | $2,468.13 | $3,005.03 | $4,964.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,485.42 / $3,064.29 / $4,732.47
| Professional | | $2,485.42 | $3,064.29 | $4,732.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,816.30 / $2,973.13
| Facility | | $80.00 | $2,816.30 | $2,973.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.26 / $3,603.00 / $6,702.00
| Facility | | $3,468.26 | $3,603.00 | $6,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,012.30 / $4,091.23 / $6,059.92
| Professional | | $3,012.30 | $4,091.23 | $6,059.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $47,540.50
| Facility | | $55.00 | $5,000.00 | $47,540.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,180.42 / $21,348.72 / $27,213.45
| Professional | | $21,180.42 | $21,348.72 | $27,213.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,828.10 / $3,590.25 / $5,830.53
| Facility | | $2,828.10 | $3,590.25 | $5,830.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,734.40 / $4,481.28 / $5,556.79
| Professional | | $3,734.40 | $4,481.28 | $5,556.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,330.51 / $5,059.47 / $11,092.06
| Professional | | $3,330.51 | $5,059.47 | $11,092.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,852.00 / $3,604.87 / $6,059.80
| Facility | | $2,852.00 | $3,604.87 | $6,059.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,080.23 / $4,229.35 / $6,228.87
| Professional | | $3,080.23 | $4,229.35 | $6,228.87 |
- 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
- $2,426.69 / $3,263.01 / $5,161.68
| Professional | | $2,426.69 | $3,263.01 | $5,161.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.76 / $2,896.10 / $3,965.02
| Professional | | $2,549.76 | $2,896.10 | $3,965.02 |