- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,925.00 / $12,281.00
| Facility | | $969.00 | $3,925.00 | $12,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,015.13 / $4,516.50 / $6,838.01
| Professional | | $4,015.13 | $4,516.50 | $6,838.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,014.02 / $5,080.77 / $7,078.66
| Professional | | $4,014.02 | $5,080.77 | $7,078.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,016.52 / $4,016.52 / $4,197.01
| Facility | | $4,016.52 | $4,016.52 | $4,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $5,017.04
| Facility | | $900.00 | $2,277.00 | $5,017.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.76 / $5,768.06 / $9,022.45
| Professional | | $3,500.76 | $5,768.06 | $9,022.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $78,093.75
| Facility | | $55.00 | $55.00 | $78,093.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,633.12 / $31,438.56 / $37,432.19
| Professional | | $30,633.12 | $31,438.56 | $37,432.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,671.79 / $4,735.43 / $9,153.86
| Facility | | $2,671.79 | $4,735.43 | $9,153.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,872.63 / $6,482.72 / $7,626.73
| Professional | | $4,872.63 | $6,482.72 | $7,626.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,802.67 / $4,663.62 / $8,725.62
| Professional | | $3,802.67 | $4,663.62 | $8,725.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,671.79 / $4,755.64 / $10,074.70
| Facility | | $2,671.79 | $4,755.64 | $10,074.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,842.25 / $6,169.49 / $10,884.94
| Professional | | $3,842.25 | $6,169.49 | $10,884.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,575.04 / $4,901.68 / $7,645.94
| Professional | | $3,575.04 | $4,901.68 | $7,645.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,616.21 / $4,200.50 / $5,659.48
| Professional | | $3,616.21 | $4,200.50 | $5,659.48 |