- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,730.00 / $10,836.00
| Facility | | $969.00 | $3,730.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,640.31 / $4,434.84 / $7,603.15
| Professional | | $3,640.31 | $4,434.84 | $7,603.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,326.79 / $7,621.06 / $17,553.00
| Facility | | $4,326.79 | $7,621.06 | $17,553.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,152.84 / $5,256.48 / $7,323.46
| Professional | | $4,152.84 | $5,256.48 | $7,323.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,121.79 / $4,121.79 / $4,121.79
| Facility | | $4,121.79 | $4,121.79 | $4,121.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,810.22 / $6,243.44 / $9,032.39
| Professional | | $4,810.22 | $6,243.44 | $9,032.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $80,161.28
| Facility | | $55.00 | $55.00 | $80,161.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,397.10 / $31,492.08 / $40,230.68
| Professional | | $31,397.10 | $31,492.08 | $40,230.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,235.39 / $5,649.01 / $10,332.66
| Facility | | $4,235.39 | $5,649.01 | $10,332.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,853.27 / $6,750.45 / $7,941.71
| Professional | | $4,853.27 | $6,750.45 | $7,941.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,887.10 / $5,887.10 / $5,887.10
| Professional | | $5,887.10 | $5,887.10 | $5,887.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,235.39 / $5,714.81 / $10,451.06
| Facility | | $4,235.39 | $5,714.81 | $10,451.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,810.22 / $6,252.63 / $9,139.54
| Professional | | $4,810.22 | $6,252.63 | $9,139.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $2,546.00 / $9,024.00
| Facility | | $448.00 | $2,546.00 | $9,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,704.37 / $5,084.25 / $8,132.62
| Professional | | $3,704.37 | $5,084.25 | $8,132.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,765.56 / $4,279.60 / $5,852.13
| Professional | | $3,765.56 | $4,279.60 | $5,852.13 |