- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $664.08 / $2,747.00 / $5,454.00
| Facility | | $664.08 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.08 / $1,200.07 / $2,703.74
| Professional | | $664.08 | $1,200.07 | $2,703.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,340.00 / $17,462.00
| Facility | | $818.35 | $3,340.00 | $17,462.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.66 / $1,839.91 / $10,227.00
| Professional | | $981.66 | $1,839.91 | $10,227.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.46 / $1,144.46 / $3,828.22
| Professional | | $1,144.46 | $1,144.46 | $3,828.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.46 / $2,061.82 / $3,664.37
| Professional | | $1,403.46 | $2,061.82 | $3,664.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.85 / $1,909.00 / $6,679.00
| Facility | | $978.85 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.96 / $1,419.33 / $2,537.67
| Professional | | $1,152.96 | $1,419.33 | $2,537.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.73 / $2,357.46 / $3,095.14
| Professional | | $1,242.73 | $2,357.46 | $3,095.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,238.00 / $18,121.91
| Facility | | $55.00 | $6,238.00 | $18,121.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,317.36 / $1,992.33 / $10,227.00
| Professional | | $1,317.36 | $1,992.33 | $10,227.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $6,474.00 / $13,737.00
| Facility | | $2,485.00 | $6,474.00 | $13,737.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.49 / $1,586.16 / $3,229.76
| Professional | | $1,222.49 | $1,586.16 | $3,229.76 |