- 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
- $2,610.86 / $2,920.85 / $4,321.64
| Professional | | $2,610.86 | $2,920.85 | $4,321.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,595.69 / $3,308.09 / $4,608.92
| Professional | | $2,595.69 | $3,308.09 | $4,608.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,568.50 / $2,568.50 / $2,678.19
| Facility | | $2,568.50 | $2,568.50 | $2,678.19 |
- 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
- $2,631.41 / $3,701.19 / $5,823.74
| Professional | | $2,631.41 | $3,701.19 | $5,823.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $25,550.40
| Facility | | $55.00 | $55.00 | $25,550.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,007.43 / $20,473.91 / $24,510.08
| Professional | | $20,007.43 | $20,473.91 | $24,510.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,576.26 / $3,217.30 / $5,802.99
| Facility | | $2,576.26 | $3,217.30 | $5,802.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,185.67 / $4,238.33 / $4,986.27
| Professional | | $3,185.67 | $4,238.33 | $4,986.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.65 / $4,955.60 / $10,344.94
| Professional | | $2,818.65 | $4,955.60 | $10,344.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,576.26 / $3,241.24 / $6,490.21
| Facility | | $2,576.26 | $3,241.24 | $6,490.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,731.09 / $3,963.64 / $7,075.75
| Professional | | $2,731.09 | $3,963.64 | $7,075.75 |
- 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
- $2,264.15 / $3,110.62 / $4,812.91
| Professional | | $2,264.15 | $3,110.62 | $4,812.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,364.23 / $2,746.34 / $3,703.20
| Professional | | $2,364.23 | $2,746.34 | $3,703.20 |