- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.08 / $2,747.00 / $5,454.00
| Facility | | $925.08 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.08 / $1,605.73 / $3,768.26
| Professional | | $925.08 | $1,605.73 | $3,768.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,218.81 / $7,231.00
| Facility | | $789.00 | $3,218.81 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,359.56 / $2,420.25 / $16,540.23
| Professional | | $1,359.56 | $2,420.25 | $16,540.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,582.05 / $2,602.46 / $3,442.07
| Professional | | $1,582.05 | $2,602.46 | $3,442.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.14 / $2,860.46 / $5,083.76
| Professional | | $1,947.14 | $2,860.46 | $5,083.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,141.88 / $8,090.00
| Facility | | $300.00 | $2,141.88 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,593.80 / $1,965.65 / $3,514.44
| Professional | | $1,593.80 | $1,965.65 | $3,514.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,724.01 / $3,270.45 / $4,293.82
| Professional | | $1,724.01 | $3,270.45 | $4,293.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $20,845.12
| Facility | | $55.00 | $2,854.00 | $20,845.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,831.04 / $2,777.06 / $16,540.23
| Professional | | $1,831.04 | $2,777.06 | $16,540.23 |
- 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
- $1,523.56 / $2,165.03 / $4,172.04
| Professional | | $1,523.56 | $2,165.03 | $4,172.04 |