- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,836.00
| Facility | | $969.00 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,852.03 / $2,240.85 / $3,057.36
| Professional | | $1,852.03 | $2,240.85 | $3,057.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,848.65 / $2,339.94 / $3,260.06
| Professional | | $1,848.65 | $2,339.94 | $3,260.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,877.55 / $1,877.55 / $1,877.55
| Facility | | $1,877.55 | $1,877.55 | $1,877.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,088.05 / $2,724.17 / $4,222.07
| Professional | | $2,088.05 | $2,724.17 | $4,222.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $36,104.80
| Facility | | $55.00 | $55.00 | $36,104.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,586.62 / $17,586.62 / $17,586.62
| Professional | | $17,586.62 | $17,586.62 | $17,586.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.36 / $2,620.98 / $4,533.75
| Facility | | $1,940.36 | $2,620.98 | $4,533.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,152.30 / $2,993.66 / $3,521.95
| Professional | | $2,152.30 | $2,993.66 | $3,521.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.51 / $2,720.63 / $5,153.75
| Facility | | $1,937.51 | $2,720.63 | $5,153.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,101.94 / $2,801.47 / $4,588.46
| Professional | | $2,101.94 | $2,801.47 | $4,588.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.05 / $2,348.57 / $3,629.60
| Professional | | $1,708.05 | $2,348.57 | $3,629.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.93 / $1,910.85 / $2,615.64
| Professional | | $1,669.93 | $1,910.85 | $2,615.64 |