- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,792.00 / $10,836.00
| Facility | | $945.00 | $3,792.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,062.51 / $5,622.09 / $9,029.23
| Professional | | $5,062.51 | $5,622.09 | $9,029.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,824.81 / $9,958.54 / $52,335.63
| Facility | | $5,824.81 | $9,958.54 | $52,335.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,124.52 / $6,646.19 / $9,259.62
| Professional | | $5,124.52 | $6,646.19 | $9,259.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,244.69 / $5,244.69 / $5,244.69
| Facility | | $5,244.69 | $5,244.69 | $5,244.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,531.94 / $7,802.13 / $12,019.51
| Professional | | $5,531.94 | $7,802.13 | $12,019.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $51,051.04
| Facility | | $55.00 | $55.00 | $51,051.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,052.16 / $41,111.36 / $48,947.03
| Professional | | $40,052.16 | $41,111.36 | $48,947.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.87 / $7,009.63 / $13,278.07
| Facility | | $5,419.87 | $7,009.63 | $13,278.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,094.34 / $8,476.67 / $9,972.56
| Professional | | $6,094.34 | $8,476.67 | $9,972.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,151.40 / $3,151.40 / $3,151.40
| Professional | | $3,151.40 | $3,151.40 | $3,151.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.87 / $7,045.83 / $13,591.23
| Facility | | $5,419.87 | $7,045.83 | $13,591.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,945.40 / $8,067.67 / $12,826.47
| Professional | | $5,945.40 | $8,067.67 | $12,826.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,934.52 / $6,700.88 / $10,893.14
| Professional | | $4,934.52 | $6,700.88 | $10,893.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,728.49 / $5,419.87 / $7,399.62
| Professional | | $4,728.49 | $5,419.87 | $7,399.62 |