- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.00 / $3,682.00 / $12,480.00
| Facility | | $1,086.00 | $3,682.00 | $12,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,733.44 / $3,329.67 / $5,148.79
| Professional | | $2,733.44 | $3,329.67 | $5,148.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,030.88 / $4,302.38 / $7,263.73
| Professional | | $3,030.88 | $4,302.38 | $7,263.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,883.15 / $2,949.90
| Facility | | $80.00 | $2,883.15 | $2,949.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,690.11 / $3,690.11 / $3,690.11
| Facility | | $3,690.11 | $3,690.11 | $3,690.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,977.68 / $4,098.88 / $6,015.24
| Professional | | $2,977.68 | $4,098.88 | $6,015.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $25,951.38
| Facility | | $55.00 | $55.00 | $25,951.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,352.24 / $23,941.52 / $27,850.05
| Professional | | $23,352.24 | $23,941.52 | $27,850.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.42 / $3,563.10 / $5,631.85
| Facility | | $2,941.42 | $3,563.10 | $5,631.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,736.57 / $4,548.87 / $5,924.99
| Professional | | $3,736.57 | $4,548.87 | $5,924.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,764.30 / $3,764.30 / $3,764.30
| Professional | | $3,764.30 | $3,764.30 | $3,764.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.42 / $3,572.84 / $5,631.85
| Facility | | $2,941.42 | $3,572.84 | $5,631.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,016.71 / $4,344.34 / $6,418.75
| Professional | | $3,016.71 | $4,344.34 | $6,418.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,524.19 / $3,387.20 / $5,316.20
| Professional | | $2,524.19 | $3,387.20 | $5,316.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,718.71 / $3,092.47 / $4,282.89
| Professional | | $2,718.71 | $3,092.47 | $4,282.89 |