- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.56 / $2,747.00 / $5,454.00
| Facility | | $793.56 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.56 / $1,352.98 / $3,176.61
| Professional | | $793.56 | $1,352.98 | $3,176.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,834.84 / $7,231.00
| Facility | | $789.00 | $2,834.84 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.52 / $2,031.19 / $10,197.06
| Professional | | $1,162.52 | $2,031.19 | $10,197.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.42 / $2,229.67 / $2,948.99
| Professional | | $1,355.42 | $2,229.67 | $2,948.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.35 / $2,440.28 / $4,337.00
| Professional | | $1,659.35 | $2,440.28 | $4,337.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.41 / $1,909.00 / $6,679.00
| Facility | | $1,157.41 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.48 / $1,678.24 / $3,000.59
| Professional | | $1,365.48 | $1,678.24 | $3,000.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.78 / $2,782.48 / $3,653.16
| Professional | | $1,466.78 | $2,782.48 | $3,653.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $17,715.52
| Facility | | $55.00 | $2,854.00 | $17,715.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.01 / $2,344.00 / $10,197.06
| Professional | | $1,555.01 | $2,344.00 | $10,197.06 |
- 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
- $1,358.63 / $1,813.43 / $3,889.03
| Professional | | $1,358.63 | $1,813.43 | $3,889.03 |