- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.55 / $2,822.00 / $6,075.00
| Facility | | $926.55 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.94 / $926.55 / $1,451.15
| Professional | | $681.94 | $926.55 | $1,451.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $5,097.00 / $13,773.00
| Facility | | $1,591.00 | $5,097.00 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.50 / $1,681.36 / $7,431.01
| Professional | | $821.50 | $1,681.36 | $7,431.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.90 / $1,138.38 / $2,032.25
| Facility | | $885.90 | $1,138.38 | $2,032.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.00 / $1,524.49 / $2,857.58
| Professional | | $853.00 | $1,524.49 | $2,857.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.24 / $1,615.34 / $6,679.00
| Facility | | $748.24 | $1,615.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.34 / $1,433.10 / $1,978.24
| Professional | | $1,180.34 | $1,433.10 | $1,978.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.30 / $2,029.62 / $2,926.09
| Professional | | $954.30 | $2,029.62 | $2,926.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,149.56 / $26,542.00
| Facility | | $2,324.00 | $5,149.56 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.38 / $2,073.11 / $7,431.01
| Professional | | $1,044.38 | $2,073.11 | $7,431.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.21 / $1,483.13 / $3,038.60
| Professional | | $990.21 | $1,483.13 | $3,038.60 |