- 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
- $1,815.94 / $2,094.96 / $2,512.11
| Professional | | $1,815.94 | $2,094.96 | $2,512.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,706.75 / $2,160.33 / $2,943.84
| Professional | | $1,706.75 | $2,160.33 | $2,943.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.16 / $1,697.16 / $1,697.16
| Facility | | $1,697.16 | $1,697.16 | $1,697.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.23 / $2,555.67 / $4,003.88
| Professional | | $1,947.23 | $2,555.67 | $4,003.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $33,191.04
| Facility | | $55.00 | $55.00 | $33,191.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,020.96 / $13,360.08 / $15,966.08
| Professional | | $13,020.96 | $13,360.08 | $15,966.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.94 / $2,268.96 / $4,193.39
| Facility | | $1,815.94 | $2,268.96 | $4,193.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,346.41 / $2,707.40 / $3,158.63
| Professional | | $2,346.41 | $2,707.40 | $3,158.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.94 / $2,268.96 / $4,300.47
| Facility | | $1,815.94 | $2,268.96 | $4,300.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.17 / $2,626.13 / $4,258.10
| Professional | | $1,947.17 | $2,626.13 | $4,258.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $2,547.00 / $9,024.00
| Facility | | $448.00 | $2,547.00 | $9,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.92 / $2,101.96 / $3,394.63
| Professional | | $1,523.92 | $2,101.96 | $3,394.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,540.45 / $1,770.16 / $2,407.08
| Professional | | $1,540.45 | $1,770.16 | $2,407.08 |