- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.92 / $2,747.00 / $5,454.00
| Facility | | $686.92 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.92 / $1,114.89 / $2,583.76
| Professional | | $686.92 | $1,114.89 | $2,583.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,348.25 / $7,231.00
| Facility | | $789.00 | $2,348.25 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.18 / $1,619.31 / $9,886.00
| Professional | | $946.18 | $1,619.31 | $9,886.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.88 / $1,808.61 / $2,399.54
| Professional | | $1,102.88 | $1,808.61 | $2,399.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.66 / $1,955.75 / $3,532.82
| Professional | | $1,353.66 | $1,955.75 | $3,532.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,508.24 / $8,090.00
| Facility | | $300.00 | $1,508.24 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.07 / $1,368.71 / $2,447.16
| Professional | | $1,111.07 | $1,368.71 | $2,447.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.31 / $2,275.09 / $2,987.00
| Professional | | $1,199.31 | $2,275.09 | $2,987.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,545.38 / $4,545.38 / $4,545.38
| Professional | | $4,545.38 | $4,545.38 | $4,545.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $14,497.28
| Facility | | $55.00 | $2,854.00 | $14,497.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.56 / $1,926.82 / $9,886.00
| Professional | | $1,271.56 | $1,926.82 | $9,886.00 |
- 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
- $1,144.96 / $1,619.31 / $3,043.85
| Professional | | $1,144.96 | $1,619.31 | $3,043.85 |