- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.88 / $2,747.00 / $5,454.00
| Facility | | $680.88 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.88 / $905.91 / $2,218.31
| Professional | | $680.88 | $905.91 | $2,218.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,208.38 / $7,231.00
| Facility | | $789.00 | $2,208.38 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.19 / $1,780.81 / $6,891.71
| Professional | | $908.19 | $1,780.81 | $6,891.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.69 / $1,040.69 / $3,965.03
| Professional | | $1,040.69 | $1,040.69 | $3,965.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.47 / $1,842.55 / $3,329.04
| Professional | | $1,271.47 | $1,842.55 | $3,329.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.58 / $1,897.58 / $6,679.00
| Facility | | $887.58 | $1,897.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.50 / $1,280.86 / $2,301.05
| Professional | | $1,018.50 | $1,280.86 | $2,301.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.53 / $2,227.29 / $2,827.92
| Professional | | $1,123.53 | $2,227.29 | $2,827.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $13,564.96
| Facility | | $55.00 | $2,854.00 | $13,564.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.91 / $1,897.58 / $6,891.71
| Professional | | $1,053.91 | $1,897.58 | $6,891.71 |
- 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
- $1,019.69 / $1,409.28 / $3,150.36
| Professional | | $1,019.69 | $1,409.28 | $3,150.36 |