- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.46 / $2,747.00 / $5,454.00
| Facility | | $960.46 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.46 / $1,644.17 / $3,841.54
| Professional | | $960.46 | $1,644.17 | $3,841.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,313.43 / $7,231.00
| Facility | | $789.00 | $3,313.43 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.13 / $2,478.35 / $22,018.91
| Professional | | $1,403.13 | $2,478.35 | $22,018.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.72 / $2,689.11 / $3,556.66
| Professional | | $1,634.72 | $2,689.11 | $3,556.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,005.98 / $2,947.35 / $5,238.20
| Professional | | $2,005.98 | $2,947.35 | $5,238.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,209.11 / $8,090.00
| Facility | | $300.00 | $2,209.11 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,646.85 / $2,027.35 / $3,624.76
| Professional | | $1,646.85 | $2,027.35 | $3,624.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,774.80 / $3,366.80 / $4,420.32
| Professional | | $1,774.80 | $3,366.80 | $4,420.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $34,850.66
| Facility | | $55.00 | $2,854.00 | $34,850.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,882.93 / $2,843.70 / $22,018.91
| Professional | | $1,882.93 | $2,843.70 | $22,018.91 |
- 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
- $1,734.11 / $2,431.51 / $4,836.14
| Professional | | $1,734.11 | $2,431.51 | $4,836.14 |