- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.20 / $2,747.00 / $5,454.00
| Facility | | $758.20 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.20 / $1,222.36 / $2,500.94
| Professional | | $758.20 | $1,222.36 | $2,500.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,601.19 / $7,231.00
| Facility | | $789.00 | $2,601.19 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.27 / $1,842.59 / $10,431.70
| Professional | | $1,051.27 | $1,842.59 | $10,431.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.67 / $2,016.34 / $2,666.84
| Professional | | $1,355.67 | $2,016.34 | $2,666.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.38 / $2,204.83 / $3,918.54
| Professional | | $1,500.38 | $2,204.83 | $3,918.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,676.27 / $8,090.00
| Facility | | $300.00 | $1,676.27 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.84 / $1,517.50 / $2,713.18
| Professional | | $1,234.84 | $1,517.50 | $2,713.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.28 / $2,515.94 / $3,303.23
| Professional | | $1,326.28 | $2,515.94 | $3,303.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $26,030.68
| Facility | | $55.00 | $2,854.00 | $26,030.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.88 / $2,117.80 / $10,431.70
| Professional | | $1,405.88 | $2,117.80 | $10,431.70 |
- 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
- $1,277.31 / $1,744.74 / $3,180.44
| Professional | | $1,277.31 | $1,744.74 | $3,180.44 |