- 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
- $1,963.99 / $2,251.56 / $2,690.29
| Professional | | $1,963.99 | $2,251.56 | $2,690.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.64 / $2,319.67 / $3,231.83
| Professional | | $1,832.64 | $2,319.67 | $3,231.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.26 / $1,850.26 / $1,850.26
| Facility | | $1,850.26 | $1,850.26 | $1,850.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.34 / $2,706.58 / $4,237.41
| Professional | | $2,076.34 | $2,706.58 | $4,237.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $58,082.44
| Facility | | $55.00 | $55.00 | $58,082.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,741.21 / $18,741.21 / $18,741.21
| Professional | | $18,741.21 | $18,741.21 | $18,741.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,989.13 / $2,494.98 / $4,515.41
| Facility | | $1,989.13 | $2,494.98 | $4,515.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,519.66 / $2,907.30 / $3,391.85
| Professional | | $2,519.66 | $2,907.30 | $3,391.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,989.13 / $2,498.30 / $5,541.90
| Facility | | $1,989.13 | $2,498.30 | $5,541.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.34 / $2,814.45 / $4,628.28
| Professional | | $2,076.34 | $2,814.45 | $4,628.28 |
- 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
- $1,699.38 / $2,279.03 / $3,561.61
| Professional | | $1,699.38 | $2,279.03 | $3,561.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,654.20 / $1,894.41 / $2,589.88
| Professional | | $1,654.20 | $1,894.41 | $2,589.88 |