- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $10,836.00
| Facility | | $969.00 | $3,682.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,876.79 / $3,286.25 / $3,938.85
| Professional | | $2,876.79 | $3,286.25 | $3,938.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,655.08 / $3,360.69 / $4,682.18
| Professional | | $2,655.08 | $3,360.69 | $4,682.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,717.69 / $2,717.69 / $2,717.69
| Facility | | $2,717.69 | $2,717.69 | $2,717.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,990.12 / $3,890.19 / $6,162.00
| Professional | | $2,990.12 | $3,890.19 | $6,162.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $68,048.61
| Facility | | $55.00 | $55.00 | $68,048.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,037.34 / $23,958.83 / $24,678.45
| Professional | | $23,037.34 | $23,958.83 | $24,678.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,880.18 / $3,580.64 / $6,550.78
| Facility | | $2,880.18 | $3,580.64 | $6,550.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,647.03 / $4,208.12 / $4,909.47
| Professional | | $3,647.03 | $4,208.12 | $4,909.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,880.18 / $3,614.00 / $7,841.17
| Facility | | $2,880.18 | $3,614.00 | $7,841.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,990.12 / $4,041.75 / $6,726.72
| Professional | | $2,990.12 | $4,041.75 | $6,726.72 |
- 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
- $2,388.54 / $3,244.49 / $5,063.07
| Professional | | $2,388.54 | $3,244.49 | $5,063.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,394.33 / $2,743.03 / $3,753.00
| Professional | | $2,394.33 | $2,743.03 | $3,753.00 |