- 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
- $1,174.71 / $1,358.22 / $1,623.75
| Professional | | $1,174.71 | $1,358.22 | $1,623.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.46 / $1,396.72 / $1,922.64
| Professional | | $1,103.46 | $1,396.72 | $1,922.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.16 / $1,098.16 / $1,098.16
| Facility | | $1,098.16 | $1,098.16 | $1,098.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.88 / $1,664.81 / $2,574.80
| Professional | | $1,258.88 | $1,664.81 | $2,574.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $14,763.65
| Facility | | $55.00 | $55.00 | $14,763.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,997.00 / $10,997.00 / $10,997.00
| Professional | | $10,997.00 | $10,997.00 | $10,997.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.76 / $1,564.48 / $2,770.35
| Facility | | $1,225.76 | $1,564.48 | $2,770.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.61 / $1,751.09 / $2,042.93
| Professional | | $1,517.61 | $1,751.09 | $2,042.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.76 / $1,630.58 / $3,076.29
| Facility | | $1,225.76 | $1,630.58 | $3,076.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.35 / $1,697.77 / $2,961.19
| Professional | | $1,258.35 | $1,697.77 | $2,961.19 |
- 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
- $1,030.72 / $1,352.82 / $2,166.21
| Professional | | $1,030.72 | $1,352.82 | $2,166.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.33 / $1,144.44 / $1,557.20
| Professional | | $996.33 | $1,144.44 | $1,557.20 |