- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,730.00 / $10,893.00
| Facility | | $945.00 | $3,730.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,485.78 / $3,988.74 / $5,828.88
| Professional | | $3,485.78 | $3,988.74 | $5,828.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,572.64 / $4,522.09 / $6,300.28
| Professional | | $3,572.64 | $4,522.09 | $6,300.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,544.24 / $3,544.24 / $3,685.48
| Facility | | $3,544.24 | $3,544.24 | $3,685.48 |
- 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
- $3,427.26 / $4,961.42 / $7,602.56
| Professional | | $3,427.26 | $4,961.42 | $7,602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $34,994.80
| Facility | | $55.00 | $55.00 | $34,994.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,880.07 / $29,833.10 / $33,533.40
| Professional | | $28,880.07 | $29,833.10 | $33,533.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,584.40 / $4,431.96 / $7,887.57
| Facility | | $3,584.40 | $4,431.96 | $7,887.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,360.03 / $5,800.73 / $6,824.39
| Professional | | $4,360.03 | $5,800.73 | $6,824.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,624.70 / $4,431.96 / $9,773.20
| Professional | | $2,624.70 | $4,431.96 | $9,773.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,584.40 / $4,449.39 / $8,842.62
| Facility | | $3,584.40 | $4,449.39 | $8,842.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,620.85 / $5,262.95 / $9,588.21
| Professional | | $3,620.85 | $5,262.95 | $9,588.21 |
- 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
- $3,073.15 / $4,103.75 / $6,638.23
| Professional | | $3,073.15 | $4,103.75 | $6,638.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.79 / $3,759.50 / $5,070.92
| Professional | | $3,235.79 | $3,759.50 | $5,070.92 |