- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.87 / $2,747.00 / $5,454.00
| Facility | | $906.87 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.87 / $1,538.58 / $3,650.44
| Professional | | $906.87 | $1,538.58 | $3,650.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,134.82 / $7,231.00
| Facility | | $789.00 | $3,134.82 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.58 / $2,206.19 / $11,425.64
| Professional | | $1,325.58 | $2,206.19 | $11,425.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,536.26 / $2,519.31 / $3,342.44
| Professional | | $1,536.26 | $2,519.31 | $3,342.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,898.06 / $2,786.30 / $4,951.97
| Professional | | $1,898.06 | $2,786.30 | $4,951.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,079.91 / $8,090.00
| Facility | | $300.00 | $2,079.91 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.66 / $1,908.78 / $3,412.77
| Professional | | $1,547.66 | $1,908.78 | $3,412.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.81 / $3,173.32 / $4,166.30
| Professional | | $1,672.81 | $3,173.32 | $4,166.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $26,536.02
| Facility | | $55.00 | $2,854.00 | $26,536.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,699.97 / $2,695.75 / $11,425.64
| Professional | | $1,699.97 | $2,695.75 | $11,425.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,372.00 / $5,876.00
| Facility | | $953.00 | $3,372.00 | $5,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.39 / $2,146.17 / $4,322.43
| Professional | | $1,618.39 | $2,146.17 | $4,322.43 |