- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.56 / $2,747.00 / $5,454.00
| Facility | | $746.56 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.56 / $1,298.56 / $3,047.34
| Professional | | $746.56 | $1,298.56 | $3,047.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,733.00 / $7,231.00
| Facility | | $789.00 | $2,733.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.53 / $1,995.01 / $11,932.00
| Professional | | $1,102.53 | $1,995.01 | $11,932.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.66 / $2,111.52 / $2,792.73
| Professional | | $1,419.66 | $2,111.52 | $2,792.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,578.12 / $2,319.40 / $4,122.16
| Professional | | $1,578.12 | $2,319.40 | $4,122.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,755.39 / $8,090.00
| Facility | | $300.00 | $1,755.39 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,293.14 / $1,593.87 / $2,849.73
| Professional | | $1,293.14 | $1,593.87 | $2,849.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.15 / $2,650.39 / $3,479.74
| Professional | | $1,397.15 | $2,650.39 | $3,479.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,297.09 / $5,297.09 / $5,297.09
| Professional | | $5,297.09 | $5,297.09 | $5,297.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $27,446.64
| Facility | | $55.00 | $2,854.00 | $27,446.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.06 / $2,248.81 / $11,932.00
| Professional | | $1,483.06 | $2,248.81 | $11,932.00 |
- 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
- $1,282.73 / $1,794.63 / $3,596.89
| Professional | | $1,282.73 | $1,794.63 | $3,596.89 |