- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,682.00 / $10,893.00
| Facility | | $945.00 | $3,682.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,858.14 / $3,503.95 / $5,115.38
| Professional | | $2,858.14 | $3,503.95 | $5,115.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,125.78 / $3,983.66 / $5,428.45
| Professional | | $3,125.78 | $3,983.66 | $5,428.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,130.76 / $3,130.76 / $3,261.64
| Facility | | $3,130.76 | $3,130.76 | $3,261.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,619.00
| Facility | | $900.00 | $2,277.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,861.40 / $4,145.83 / $6,304.99
| Professional | | $2,861.40 | $4,145.83 | $6,304.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $60,356.16
| Facility | | $55.00 | $55.00 | $60,356.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,671.52 / $24,628.96 / $28,899.30
| Professional | | $23,671.52 | $24,628.96 | $28,899.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,921.10 / $3,596.29 / $6,831.38
| Facility | | $2,921.10 | $3,596.29 | $6,831.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,763.00 / $5,006.42 / $5,889.91
| Professional | | $3,763.00 | $5,006.42 | $5,889.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,096.93 / $3,596.29 / $6,419.38
| Professional | | $3,096.93 | $3,596.29 | $6,419.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,921.10 / $3,607.56 / $7,751.54
| Facility | | $2,921.10 | $3,607.56 | $7,751.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,944.97 / $4,362.14 / $8,469.45
| Professional | | $2,944.97 | $4,362.14 | $8,469.45 |
- 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
- $2,410.92 / $3,472.13 / $5,671.10
| Professional | | $2,410.92 | $3,472.13 | $5,671.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,792.70 / $3,244.59 / $4,373.07
| Professional | | $2,792.70 | $3,244.59 | $4,373.07 |