- 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
- $978.42 / $1,129.72 / $1,350.24
| Professional | | $978.42 | $1,129.72 | $1,350.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,923.76 / $6,894.28 / $14,523.96
| Facility | | $3,923.76 | $6,894.28 | $14,523.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.04 / $914.04 / $914.04
| Facility | | $914.04 | $914.04 | $914.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.14 / $1,420.15 / $2,242.46
| Professional | | $1,047.14 | $1,420.15 | $2,242.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $13,856.55
| Facility | | $55.00 | $55.00 | $13,856.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,025.81 / $7,196.00 / $8,601.75
| Professional | | $7,025.81 | $7,196.00 | $8,601.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.15 / $1,360.47 / $2,253.06
| Facility | | $1,045.15 | $1,360.47 | $2,253.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.46 / $1,458.99 / $1,750.79
| Professional | | $1,264.46 | $1,458.99 | $1,750.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.92 / $1,519.39 / $2,175.32
| Professional | | $1,012.92 | $1,519.39 | $2,175.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.15 / $1,394.75 / $2,559.71
| Facility | | $1,045.15 | $1,394.75 | $2,559.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.14 / $1,452.71 / $2,481.73
| Professional | | $1,047.14 | $1,452.71 | $2,481.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,605.00 / $7,184.00 / $16,000.00
| Facility | | $2,605.00 | $7,184.00 | $16,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.25 / $1,225.63 / $1,863.42
| Professional | | $909.25 | $1,225.63 | $1,863.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.14 / $952.84 / $1,297.89
| Professional | | $830.14 | $952.84 | $1,297.89 |