- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.20 / $2,747.00 / $5,454.00
| Facility | | $834.20 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.20 / $1,417.46 / $3,321.99
| Professional | | $834.20 | $1,417.46 | $3,321.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,857.08 / $7,231.00
| Facility | | $789.00 | $2,857.08 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,197.46 / $1,977.55 / $8,763.92
| Professional | | $1,197.46 | $1,977.55 | $8,763.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.63 / $2,540.69 / $4,515.43
| Professional | | $1,723.63 | $2,540.69 | $4,515.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,909.00 / $8,090.00
| Facility | | $300.00 | $1,909.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,416.41 / $1,745.42 / $3,120.70
| Professional | | $1,416.41 | $1,745.42 | $3,120.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.17 / $2,895.14 / $3,801.08
| Professional | | $1,526.17 | $2,895.14 | $3,801.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,244.52 / $1,244.52 / $1,244.52
| Professional | | $1,244.52 | $1,244.52 | $1,244.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $18,427.84
| Facility | | $55.00 | $2,854.00 | $18,427.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.57 / $2,459.21 / $8,763.92
| Professional | | $1,419.57 | $2,459.21 | $8,763.92 |
- 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
- $1,386.40 / $1,957.87 / $3,701.69
| Professional | | $1,386.40 | $1,957.87 | $3,701.69 |