- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.21 / $2,747.00 / $5,454.00
| Facility | | $696.21 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.21 / $941.43 / $2,231.73
| Professional | | $696.21 | $941.43 | $2,231.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,320.52 / $6,214.25
| Facility | | $789.00 | $2,320.52 | $6,214.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.61 / $1,849.08 / $6,621.84
| Professional | | $887.61 | $1,849.08 | $6,621.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.14 / $1,899.05 / $3,501.73
| Professional | | $1,029.14 | $1,899.05 | $3,501.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,482.92 / $8,090.00
| Facility | | $300.00 | $1,482.92 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.45 / $1,058.41 / $1,706.37
| Professional | | $568.45 | $1,058.41 | $1,706.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.08 / $2,325.53 / $2,952.67
| Professional | | $1,173.08 | $2,325.53 | $2,952.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,951.61 / $1,951.61 / $1,951.61
| Professional | | $1,951.61 | $1,951.61 | $1,951.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $7,231.00
| Facility | | $55.00 | $2,854.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.63 / $1,977.22 / $6,621.84
| Professional | | $1,000.63 | $1,977.22 | $6,621.84 |
- 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
- $973.59 / $1,326.59 / $2,818.31
| Professional | | $973.59 | $1,326.59 | $2,818.31 |