- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.00 / $3,596.00 / $12,040.00
| Facility | | $921.00 | $3,596.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.37 / $1,078.77 / $1,856.11
| Professional | | $920.37 | $1,078.77 | $1,856.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.71 / $1,858.33 / $6,871.25
| Facility | | $1,112.71 | $1,858.33 | $6,871.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.58 / $964.18 / $1,674.46
| Professional | | $769.58 | $964.18 | $1,674.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.33 / $1,311.33 / $1,395.10
| Facility | | $1,311.33 | $1,311.33 | $1,395.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.66 / $1,592.87 / $2,339.40
| Professional | | $1,186.66 | $1,592.87 | $2,339.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $19,385.75
| Facility | | $55.00 | $55.00 | $19,385.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,913.44 / $10,159.68 / $13,012.88
| Professional | | $9,913.44 | $10,159.68 | $13,012.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.83 / $1,398.58 / $1,949.50
| Facility | | $999.83 | $1,398.58 | $1,949.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.86 / $2,180.04 / $2,849.72
| Professional | | $1,424.86 | $2,180.04 | $2,849.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.36 / $1,402.61 / $1,988.96
| Facility | | $1,010.36 | $1,402.61 | $1,988.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.05 / $1,620.40 / $2,339.40
| Professional | | $1,236.05 | $1,620.40 | $2,339.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,064.00 / $8,759.00
| Facility | | $405.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.55 / $1,148.73 / $1,747.22
| Professional | | $861.55 | $1,148.73 | $1,747.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.08 / $1,383.51 / $1,888.08
| Professional | | $1,216.08 | $1,383.51 | $1,888.08 |