- 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
- $2,467.53 / $3,004.34 / $4,988.54
| Professional | | $2,467.53 | $3,004.34 | $4,988.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.12 / $5,351.68 / $26,777.64
| Facility | | $3,060.12 | $5,351.68 | $26,777.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,808.98 / $3,555.49 / $4,844.99
| Professional | | $2,808.98 | $3,555.49 | $4,844.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,815.64 / $2,972.48
| Facility | | $80.00 | $2,815.64 | $2,972.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.87 / $3,603.00 / $6,702.00
| Facility | | $3,467.87 | $3,603.00 | $6,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,027.34 / $4,115.26 / $6,059.23
| Professional | | $3,027.34 | $4,115.26 | $6,059.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $47,534.90
| Facility | | $55.00 | $5,000.00 | $47,534.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,178.20 / $21,346.08 / $27,210.83
| Professional | | $21,178.20 | $21,346.08 | $27,210.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,891.43 / $3,621.76 / $5,829.24
| Facility | | $2,891.43 | $3,621.76 | $5,829.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,734.00 / $4,480.80 / $5,556.19
| Professional | | $3,734.00 | $4,480.80 | $5,556.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,330.14 / $5,058.10 / $11,090.80
| Professional | | $3,330.14 | $5,058.10 | $11,090.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,895.77 / $3,630.37 / $6,060.35
| Facility | | $2,895.77 | $3,630.37 | $6,060.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,079.49 / $4,228.93 / $6,222.75
| Professional | | $3,079.49 | $4,228.93 | $6,222.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $9,027.00 / $20,955.00
| Facility | | $4,600.00 | $9,027.00 | $20,955.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,426.15 / $3,291.70 / $5,185.21
| Professional | | $2,426.15 | $3,291.70 | $5,185.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.48 / $2,895.77 / $3,964.57
| Professional | | $2,549.48 | $2,895.77 | $3,964.57 |