- 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
- $1,151.52 / $1,330.95 / $1,591.43
| Professional | | $1,151.52 | $1,330.95 | $1,591.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.92 / $1,249.93 / $1,865.05
| Professional | | $1,073.92 | $1,249.93 | $1,865.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.82 / $1,076.82 / $1,076.82
| Facility | | $1,076.82 | $1,076.82 | $1,076.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.74 / $1,633.09 / $2,526.71
| Professional | | $1,234.74 | $1,633.09 | $2,526.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,847.96
| Facility | | $55.00 | $55.00 | $11,847.96 |
- 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
- $1,202.32 / $1,529.64 / $2,719.14
| Facility | | $1,202.32 | $1,529.64 | $2,719.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.59 / $1,717.61 / $2,003.87
| Professional | | $1,488.59 | $1,717.61 | $2,003.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.32 / $1,599.53 / $3,014.51
| Facility | | $1,202.32 | $1,599.53 | $3,014.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.34 / $1,665.19 / $2,890.01
| Professional | | $1,234.34 | $1,665.19 | $2,890.01 |
- 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
- $1,011.09 / $1,327.05 / $2,122.71
| Professional | | $1,011.09 | $1,327.05 | $2,122.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.28 / $1,122.49 / $1,527.39
| Professional | | $977.28 | $1,122.49 | $1,527.39 |