- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,849.00 / $12,078.31
| Facility | | $945.00 | $3,849.00 | $12,078.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,921.53 / $4,419.60 / $6,506.11
| Professional | | $3,921.53 | $4,419.60 | $6,506.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,925.99 / $4,974.45 / $6,923.41
| Professional | | $3,925.99 | $4,974.45 | $6,923.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,947.26 / $3,947.26 / $4,119.49
| Facility | | $3,947.26 | $3,947.26 | $4,119.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,904.50
| Facility | | $900.00 | $2,277.00 | $4,904.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,557.10 / $5,643.18 / $8,819.51
| Professional | | $3,557.10 | $5,643.18 | $8,819.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $76,487.36
| Facility | | $55.00 | $55.00 | $76,487.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,001.76 / $30,776.64 / $36,642.75
| Professional | | $30,001.76 | $30,776.64 | $36,642.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,798.89 / $4,628.91 / $9,368.46
| Facility | | $2,798.89 | $4,628.91 | $9,368.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,770.71 / $6,347.11 / $7,467.19
| Professional | | $4,770.71 | $6,347.11 | $7,467.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,724.17 / $4,568.82 / $8,277.20
| Professional | | $3,724.17 | $4,568.82 | $8,277.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,798.89 / $4,651.84 / $9,846.68
| Facility | | $2,798.89 | $4,651.84 | $9,846.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,766.34 / $6,024.43 / $10,636.92
| Professional | | $3,766.34 | $6,024.43 | $10,636.92 |
- 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
- $3,514.63 / $4,749.47 / $7,568.18
| Professional | | $3,514.63 | $4,749.47 | $7,568.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,540.57 / $4,113.04 / $5,542.48
| Professional | | $3,540.57 | $4,113.04 | $5,542.48 |