- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.03 / $2,747.00 / $5,454.00
| Facility | | $918.03 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.03 / $1,586.70 / $3,615.42
| Professional | | $918.03 | $1,586.70 | $3,615.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,199.61 / $7,231.00
| Facility | | $789.00 | $3,199.61 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.45 / $2,391.59 / $16,108.00
| Professional | | $1,355.45 | $2,391.59 | $16,108.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,881.45 / $2,590.58 / $3,437.00
| Professional | | $1,881.45 | $2,590.58 | $3,437.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,937.28 / $2,846.51 / $5,058.96
| Professional | | $1,937.28 | $2,846.51 | $5,058.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,134.19 / $8,090.00
| Facility | | $300.00 | $2,134.19 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.45 / $1,958.59 / $3,501.82
| Professional | | $1,591.45 | $1,958.59 | $3,501.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,714.18 / $3,251.80 / $4,269.34
| Professional | | $1,714.18 | $3,251.80 | $4,269.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $33,658.04
| Facility | | $55.00 | $2,854.00 | $33,658.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,817.97 / $2,746.04 / $16,108.00
| Professional | | $1,817.97 | $2,746.04 | $16,108.00 |
- 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
- $1,638.24 / $2,332.51 / $4,634.43
| Professional | | $1,638.24 | $2,332.51 | $4,634.43 |