- 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
- $3,871.28 / $4,358.51 / $6,370.20
| Professional | | $3,871.28 | $4,358.51 | $6,370.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,911.22 / $4,950.64 / $6,897.36
| Professional | | $3,911.22 | $4,950.64 | $6,897.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,891.20 / $3,891.20 / $4,044.73
| Facility | | $3,891.20 | $3,891.20 | $4,044.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,856.28
| Facility | | $900.00 | $2,277.00 | $4,856.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,061.63 / $5,441.96 / $8,414.62
| Professional | | $4,061.63 | $5,441.96 | $8,414.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $67,211.06
| Facility | | $55.00 | $55.00 | $67,211.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,072.24 / $30,727.60 / $36,794.33
| Professional | | $30,072.24 | $30,727.60 | $36,794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,032.06 / $4,907.57 / $9,212.51
| Facility | | $4,032.06 | $4,907.57 | $9,212.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,784.47 / $6,365.43 / $7,488.74
| Professional | | $4,784.47 | $6,365.43 | $7,488.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $4,725.20 / $10,679.30
| Professional | | $13.00 | $4,725.20 | $10,679.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,032.06 / $4,952.14 / $9,704.44
| Facility | | $4,032.06 | $4,952.14 | $9,704.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,150.82 / $5,835.69 / $10,642.68
| Professional | | $4,150.82 | $5,835.69 | $10,642.68 |
- 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
- $3,371.22 / $4,509.38 / $7,191.94
| Professional | | $3,371.22 | $4,509.38 | $7,191.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,550.79 / $4,125.64 / $5,565.04
| Professional | | $3,550.79 | $4,125.64 | $5,565.04 |