- 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
- $2,638.53 / $3,010.29 / $4,506.27
| Professional | | $2,638.53 | $3,010.29 | $4,506.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,436.83 / $3,207.57 / $4,670.25
| Professional | | $2,436.83 | $3,207.57 | $4,670.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,610.96 / $2,610.96 / $2,716.75
| Facility | | $2,610.96 | $2,610.96 | $2,716.75 |
- 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
- $2,745.69 / $3,807.13 / $5,914.51
| Professional | | $2,745.69 | $3,807.13 | $5,914.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $29,063.16
| Facility | | $55.00 | $55.00 | $29,063.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,228.24 / $20,730.64 / $24,760.35
| Professional | | $20,228.24 | $20,730.64 | $24,760.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,739.06 / $3,409.31 / $5,884.76
| Facility | | $2,739.06 | $3,409.31 | $5,884.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,219.16 / $4,282.88 / $5,038.68
| Professional | | $3,219.16 | $4,282.88 | $5,038.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,950.90 / $5,228.46 / $10,449.17
| Professional | | $2,950.90 | $5,228.46 | $10,449.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,739.06 / $3,428.11 / $6,570.78
| Facility | | $2,739.06 | $3,428.11 | $6,570.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,856.55 / $4,015.04 / $7,160.41
| Professional | | $2,856.55 | $4,015.04 | $7,160.41 |
- 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
- $2,346.78 / $3,158.88 / $4,983.10
| Professional | | $2,346.78 | $3,158.88 | $4,983.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,389.09 / $2,775.65 / $3,743.63
| Professional | | $2,389.09 | $2,775.65 | $3,743.63 |