- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.66 / $2,747.00 / $5,454.00
| Facility | | $898.66 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.66 / $1,184.80 / $2,885.54
| Professional | | $898.66 | $1,184.80 | $2,885.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,854.00 / $7,231.00
| Facility | | $789.00 | $2,854.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.28 / $2,327.25 / $9,848.32
| Professional | | $1,216.28 | $2,327.25 | $9,848.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.17 / $1,393.17 / $5,307.98
| Professional | | $1,393.17 | $1,393.17 | $5,307.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,510.20 / $2,463.08 / $4,484.91
| Professional | | $1,510.20 | $2,463.08 | $4,484.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,905.23 / $8,090.00
| Facility | | $300.00 | $1,905.23 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.05 / $1,714.70 / $3,001.89
| Professional | | $1,361.05 | $1,714.70 | $3,001.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.66 / $2,931.30 / $3,721.79
| Professional | | $1,478.66 | $2,931.30 | $3,721.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,933.21 / $1,933.21 / $1,933.21
| Professional | | $1,933.21 | $1,933.21 | $1,933.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $21,044.21
| Facility | | $55.00 | $2,854.00 | $21,044.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.03 / $2,540.30 / $9,848.32
| Professional | | $1,378.03 | $2,540.30 | $9,848.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.03 / $1,832.52 / $3,643.40
| Professional | | $1,378.03 | $1,832.52 | $3,643.40 |