- 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
- $4,305.39 / $4,789.93 / $7,138.99
| Professional | | $4,305.39 | $4,789.93 | $7,138.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,293.18 / $5,435.54 / $7,570.97
| Professional | | $4,293.18 | $5,435.54 | $7,570.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,273.34 / $4,273.34 / $4,445.46
| Facility | | $4,273.34 | $4,273.34 | $4,445.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $5,349.05
| Facility | | $900.00 | $2,277.00 | $5,349.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,476.04 / $6,159.09 / $9,623.65
| Professional | | $4,476.04 | $6,159.09 | $9,623.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $73,966.20
| Facility | | $55.00 | $55.00 | $73,966.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,095.04 / $33,817.44 / $40,507.05
| Professional | | $33,095.04 | $33,817.44 | $40,507.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,431.32 / $5,419.69 / $10,165.75
| Facility | | $4,431.32 | $5,419.69 | $10,165.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,266.56 / $7,006.82 / $8,243.32
| Professional | | $5,266.56 | $7,006.82 | $8,243.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $5,189.50 / $11,726.30
| Professional | | $13.00 | $5,189.50 | $11,726.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,431.32 / $5,502.84 / $10,708.58
| Facility | | $4,431.32 | $5,502.84 | $10,708.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,642.39 / $6,530.32 / $11,717.16
| Professional | | $4,642.39 | $6,530.32 | $11,717.16 |
- 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
- $3,721.32 / $5,040.33 / $7,969.80
| Professional | | $3,721.32 | $5,040.33 | $7,969.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,908.57 / $4,541.04 / $6,124.80
| Professional | | $3,908.57 | $4,541.04 | $6,124.80 |