- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,849.00 / $10,893.00
| Facility | | $945.00 | $3,849.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,065.26 / $4,580.67 / $6,936.06
| Professional | | $4,065.26 | $4,580.67 | $6,936.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,069.73 / $5,151.29 / $7,176.90
| Professional | | $4,069.73 | $5,151.29 | $7,176.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,088.51 / $4,088.51 / $4,267.51
| Facility | | $4,088.51 | $4,088.51 | $4,267.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $5,083.51
| Facility | | $900.00 | $2,277.00 | $5,083.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,540.74 / $5,832.89 / $9,131.62
| Professional | | $3,540.74 | $5,832.89 | $9,131.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $79,268.80
| Facility | | $55.00 | $55.00 | $79,268.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,092.96 / $31,893.44 / $37,977.98
| Professional | | $31,092.96 | $31,893.44 | $37,977.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,633.27 / $4,798.34 / $9,643.00
| Facility | | $2,633.27 | $4,798.34 | $9,643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,944.43 / $6,578.24 / $7,739.10
| Professional | | $4,944.43 | $6,578.24 | $7,739.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,859.63 / $4,736.60 / $8,577.29
| Professional | | $3,859.63 | $4,736.60 | $8,577.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,633.27 / $4,809.70 / $10,207.54
| Facility | | $2,633.27 | $4,809.70 | $10,207.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,858.99 / $6,245.67 / $11,039.78
| Professional | | $3,858.99 | $6,245.67 | $11,039.78 |
- 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
- $3,554.90 / $4,928.82 / $7,886.11
| Professional | | $3,554.90 | $4,928.82 | $7,886.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,669.49 / $4,262.75 / $5,744.12
| Professional | | $3,669.49 | $4,262.75 | $5,744.12 |