- 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
- $2,236.71 / $2,721.50 / $4,453.84
| Professional | | $2,236.71 | $2,721.50 | $4,453.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,758.54 / $4,562.74 / $10,309.48
| Facility | | $2,758.54 | $4,562.74 | $10,309.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,544.58 / $3,220.82 / $4,388.95
| Professional | | $2,544.58 | $3,220.82 | $4,388.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,560.26 / $2,699.97
| Facility | | $80.00 | $2,560.26 | $2,699.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,140.83 / $3,603.00 / $6,702.00
| Facility | | $3,140.83 | $3,603.00 | $6,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,742.47 / $3,721.94 / $5,502.91
| Professional | | $2,742.47 | $3,721.94 | $5,502.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $27,702.36
| Facility | | $55.00 | $5,000.00 | $27,702.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,167.00 / $19,353.91 / $24,650.40
| Professional | | $19,167.00 | $19,353.91 | $24,650.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.21 / $3,339.68 / $5,352.36
| Facility | | $2,621.21 | $3,339.68 | $5,352.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,383.85 / $4,060.62 / $5,035.17
| Professional | | $3,383.85 | $4,060.62 | $5,035.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,027.86 / $4,587.12 / $10,048.50
| Professional | | $3,027.86 | $4,587.12 | $10,048.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,623.63 / $3,353.29 / $5,457.71
| Facility | | $2,623.63 | $3,353.29 | $5,457.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.39 / $3,829.65 / $5,675.78
| Professional | | $2,784.39 | $3,829.65 | $5,675.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $8,848.00 / $20,955.00
| Facility | | $4,600.00 | $8,848.00 | $20,955.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,191.54 / $2,908.38 / $4,653.41
| Professional | | $2,191.54 | $2,908.38 | $4,653.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,310.41 / $2,623.63 / $3,593.58
| Professional | | $2,310.41 | $2,623.63 | $3,593.58 |