- 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
- $2,715.01 / $3,181.03 / $5,450.90
| Professional | | $2,715.01 | $3,181.03 | $5,450.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,993.20 / $3,164.57 / $4,916.13
| Professional | | $1,993.20 | $3,164.57 | $4,916.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,805.62 / $2,805.62 / $2,923.78
| Facility | | $2,805.62 | $2,805.62 | $2,923.78 |
- 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
- $2,946.43 / $3,948.84 / $6,041.02
| Professional | | $2,946.43 | $3,948.84 | $6,041.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $55,764.32
| Facility | | $55.00 | $55.00 | $55,764.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,833.04 / $22,337.92 / $26,740.05
| Professional | | $21,833.04 | $22,337.92 | $26,740.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,938.80 / $3,659.78 / $6,345.34
| Facility | | $2,938.80 | $3,659.78 | $6,345.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,475.83 / $4,624.35 / $5,440.43
| Professional | | $3,475.83 | $4,624.35 | $5,440.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $4,465.39 / $7,777.10
| Professional | | $15.00 | $4,465.39 | $7,777.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,943.45 / $3,680.09 / $6,684.16
| Facility | | $2,943.45 | $3,680.09 | $6,684.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,004.41 / $4,210.10 / $7,490.29
| Professional | | $3,004.41 | $4,210.10 | $7,490.29 |
- 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
- $2,423.06 / $3,231.98 / $5,146.08
| Professional | | $2,423.06 | $3,231.98 | $5,146.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,579.58 / $2,996.62 / $4,040.96
| Professional | | $2,579.58 | $2,996.62 | $4,040.96 |