- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.99 / $3,745.00 / $8,017.00
| Facility | | $882.99 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.99 / $1,034.68 / $1,280.67
| Professional | | $882.99 | $1,034.68 | $1,280.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.77 / $1,046.83 / $1,046.83
| Professional | | $1,008.77 | $1,046.83 | $1,046.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.18 / $1,304.32 / $2,010.75
| Professional | | $973.18 | $1,304.32 | $2,010.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.04 / $1,553.28 / $1,558.20
| Professional | | $1,174.04 | $1,553.28 | $1,558.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,291.45 / $15,291.45 / $15,291.45
| Facility | | $15,291.45 | $15,291.45 | $15,291.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,839.00 / $8,017.00
| Facility | | $954.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.68 / $1,070.56 / $3,494.00
| Professional | | $883.68 | $1,070.56 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,426.40 / $2,502.19
| Professional | | $3.00 | $1,426.40 | $2,502.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.25 / $1,315.25 / $2,213.42
| Professional | | $999.25 | $1,315.25 | $2,213.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.58 / $979.58 / $1,171.68
| Facility | | $979.58 | $979.58 | $1,171.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.79 / $984.49 / $1,171.68
| Professional | | $949.79 | $984.49 | $1,171.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,000.00
| Facility | | $2,155.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.09 / $1,254.83 / $2,064.51
| Professional | | $949.09 | $1,254.83 | $2,064.51 |