- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.05 / $1,088.41 / $6,391.20
| Facility | | $986.05 | $1,088.41 | $6,391.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.71 / $1,096.48 / $4,248.00
| Professional | | $940.71 | $1,096.48 | $4,248.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.03 / $1,625.34 / $2,163.35
| Professional | | $1,030.03 | $1,625.34 | $2,163.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.31 / $1,443.21 / $2,309.42
| Professional | | $1,111.31 | $1,443.21 | $2,309.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.00 / $1,919.76 / $2,000.00
| Professional | | $1,050.00 | $1,919.76 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.41 / $1,088.41 / $6,391.20
| Facility | | $1,088.41 | $1,088.41 | $6,391.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.04 / $1,602.87 / $4,235.00
| Professional | | $986.04 | $1,602.87 | $4,235.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,000.00 / $2,821.40
| Professional | | $5.00 | $1,000.00 | $2,821.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.34 / $1,447.49 / $2,345.40
| Professional | | $1,106.34 | $1,447.49 | $2,345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.51 / $1,124.51 / $1,803.00
| Facility | | $1,124.51 | $1,124.51 | $1,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.48 / $1,150.57 / $1,803.00
| Professional | | $1,069.48 | $1,150.57 | $1,803.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $1,618.00 / $4,789.00
| Facility | | $656.00 | $1,618.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,130.84 / $1,403.60 / $2,185.42
| Professional | | $1,130.84 | $1,403.60 | $2,185.42 |