- 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
- $1,778.97 / $2,103.91 / $3,438.68
| Professional | | $1,778.97 | $2,103.91 | $3,438.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.14 / $2,568.75 / $4,340.13
| Professional | | $2,032.14 | $2,568.75 | $4,340.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.69 / $2,047.69 / $2,047.69
| Facility | | $2,047.69 | $2,047.69 | $2,047.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,292.63 / $2,977.06 / $4,374.12
| Professional | | $2,292.63 | $2,977.06 | $4,374.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $29,364.72
| Facility | | $55.00 | $55.00 | $29,364.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,516.93 / $16,516.93 / $19,576.58
| Professional | | $16,516.93 | $16,516.93 | $19,576.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.39 / $2,750.59 / $4,911.17
| Facility | | $2,059.39 | $2,750.59 | $4,911.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.14 / $3,291.09 / $3,871.87
| Professional | | $2,366.14 | $3,291.09 | $3,871.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.39 / $2,775.53 / $5,049.43
| Facility | | $2,059.39 | $2,775.53 | $5,049.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,314.80 / $3,021.88 / $4,437.60
| Professional | | $2,314.80 | $3,021.88 | $4,437.60 |
- 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
- $1,818.05 / $2,466.12 / $3,863.35
| Professional | | $1,818.05 | $2,466.12 | $3,863.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.85 / $2,084.05 / $2,856.38
| Professional | | $1,835.85 | $2,084.05 | $2,856.38 |