- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.08 / $2,747.00 / $5,454.00
| Facility | | $907.08 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.08 / $1,554.86 / $3,378.79
| Professional | | $907.08 | $1,554.86 | $3,378.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,144.70 / $7,231.00
| Facility | | $789.00 | $3,144.70 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.32 / $2,186.55 / $13,125.00
| Professional | | $1,274.32 | $2,186.55 | $13,125.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,916.19 / $2,796.30 / $4,969.72
| Professional | | $1,916.19 | $2,796.30 | $4,969.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,094.64 / $8,090.00
| Facility | | $300.00 | $2,094.64 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,559.90 / $1,922.29 / $3,436.93
| Professional | | $1,559.90 | $1,922.29 | $3,436.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.46 / $3,193.52 / $4,192.83
| Professional | | $1,683.46 | $3,193.52 | $4,192.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.87 / $376.87 / $1,045.13
| Professional | | $376.87 | $376.87 | $1,045.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $26,699.82
| Facility | | $55.00 | $2,854.00 | $26,699.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,616.01 / $2,713.95 / $13,125.00
| Professional | | $1,616.01 | $2,713.95 | $13,125.00 |
- 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
- $1,497.78 / $2,152.17 / $4,192.83
| Professional | | $1,497.78 | $2,152.17 | $4,192.83 |