- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.00 / $3,682.00 / $10,893.00
| Facility | | $935.00 | $3,682.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.05 / $2,843.01 / $4,245.63
| Professional | | $2,510.05 | $2,843.01 | $4,245.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,485.48 / $3,146.83 / $4,383.10
| Professional | | $2,485.48 | $3,146.83 | $4,383.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,436.64 / $2,436.64 / $2,500.17
| Facility | | $2,436.64 | $2,436.64 | $2,500.17 |
- 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
- $2,636.44 / $3,694.76 / $5,688.57
| Professional | | $2,636.44 | $3,694.76 | $5,688.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $27,678.42
| Facility | | $55.00 | $55.00 | $27,678.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,347.14 / $21,347.14 / $22,739.55
| Professional | | $21,347.14 | $21,347.14 | $22,739.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,619.50 / $3,338.82 / $5,873.29
| Facility | | $2,619.50 | $3,338.82 | $5,873.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,028.33 / $4,028.99 / $4,739.99
| Professional | | $3,028.33 | $4,028.99 | $4,739.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,575.10 / $3,123.80 / $6,816.70
| Professional | | $2,575.10 | $3,123.80 | $6,816.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,619.50 / $3,356.35 / $6,300.18
| Facility | | $2,619.50 | $3,356.35 | $6,300.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,738.29 / $3,849.37 / $6,771.97
| Professional | | $2,738.29 | $3,849.37 | $6,771.97 |
- 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
- $2,307.55 / $3,048.48 / $4,863.46
| Professional | | $2,307.55 | $3,048.48 | $4,863.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,247.46 / $2,624.83 / $3,544.80
| Professional | | $2,247.46 | $2,624.83 | $3,544.80 |