- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.47 / $2,747.00 / $5,454.00
| Facility | | $718.47 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.47 / $928.70 / $2,298.31
| Professional | | $718.47 | $928.70 | $2,298.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,280.30 / $7,231.00
| Facility | | $789.00 | $2,280.30 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.22 / $1,845.00 / $6,653.20
| Professional | | $932.22 | $1,845.00 | $6,653.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.82 / $1,896.88 / $3,437.91
| Professional | | $1,214.82 | $1,896.88 | $3,437.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,471.94 / $8,090.00
| Facility | | $300.00 | $1,471.94 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.05 / $1,324.74 / $2,341.61
| Professional | | $1,053.05 | $1,324.74 | $2,341.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,159.99 / $2,299.56 / $2,919.69
| Professional | | $1,159.99 | $2,299.56 | $2,919.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,597.88 / $11,597.88 / $11,597.88
| Facility | | $11,597.88 | $11,597.88 | $11,597.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,472.83 / $1,472.83 / $1,582.75
| Professional | | $1,472.83 | $1,472.83 | $1,582.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $11,371.75
| Facility | | $55.00 | $2,854.00 | $11,371.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.76 / $1,962.58 / $6,653.20
| Professional | | $1,074.76 | $1,962.58 | $6,653.20 |
- 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
- $1,057.08 / $1,369.33 / $3,155.15
| Professional | | $1,057.08 | $1,369.33 | $3,155.15 |