- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.95 / $2,900.00 / $7,276.00
| Facility | | $856.95 | $2,900.00 | $7,276.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.95 / $1,467.54 / $6,419.35
| Professional | | $856.95 | $1,467.54 | $6,419.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,033.20 / $7,231.00
| Facility | | $789.00 | $3,033.20 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.55 / $2,114.71 / $9,155.68
| Professional | | $1,216.55 | $2,114.71 | $9,155.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,792.48 / $2,691.78 / $4,783.97
| Professional | | $1,792.48 | $2,691.78 | $4,783.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,958.69 / $8,090.00
| Facility | | $300.00 | $1,958.69 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.71 / $1,797.54 / $3,213.87
| Professional | | $1,450.71 | $1,797.54 | $3,213.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.03 / $2,965.07 / $3,892.88
| Professional | | $1,563.03 | $2,965.07 | $3,892.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,440.69 / $33,440.69 / $33,440.69
| Facility | | $33,440.69 | $33,440.69 | $33,440.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $18,800.96
| Facility | | $55.00 | $2,854.00 | $18,800.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.05 / $2,336.03 / $9,155.68
| Professional | | $1,614.05 | $2,336.03 | $9,155.68 |
- 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
- $1,528.51 / $1,997.92 / $4,334.52
| Professional | | $1,528.51 | $1,997.92 | $4,334.52 |