- 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
- $2,006.96 / $2,439.98 / $4,062.50
| Professional | | $2,006.96 | $2,439.98 | $4,062.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,282.03 / $2,888.49 / $3,936.09
| Professional | | $2,282.03 | $2,888.49 | $3,936.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,306.14 / $2,428.90
| Facility | | $80.00 | $2,306.14 | $2,428.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,814.58 / $2,814.58 / $2,814.58
| Facility | | $2,814.58 | $2,814.58 | $2,814.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.57 / $3,219.95 / $4,701.84
| Professional | | $2,299.57 | $3,219.95 | $4,701.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,000.00 / $44,205.44
| Facility | | $55.00 | $5,000.00 | $44,205.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,978.72 / $17,369.36 / $22,108.80
| Professional | | $16,978.72 | $17,369.36 | $22,108.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,223.51 / $2,810.41 / $4,621.70
| Facility | | $2,223.51 | $2,810.41 | $4,621.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,036.13 / $3,643.35 / $4,517.75
| Professional | | $3,036.13 | $3,643.35 | $4,517.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,452.00 / $2,452.00 / $2,452.00
| Professional | | $2,452.00 | $2,452.00 | $2,452.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,225.33 / $2,824.02 / $4,789.89
| Facility | | $2,225.33 | $2,824.02 | $4,789.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,317.03 / $3,336.88 / $4,928.46
| Professional | | $2,317.03 | $3,336.88 | $4,928.46 |
- 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
- $1,923.13 / $2,564.17 / $4,101.58
| Professional | | $1,923.13 | $2,564.17 | $4,101.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,072.98 / $2,353.35 / $3,225.12
| Professional | | $2,072.98 | $2,353.35 | $3,225.12 |