- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.03 / $2,663.12 / $4,712.00
| Facility | | $908.03 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.61 / $619.82 / $1,074.81
| Professional | | $465.61 | $619.82 | $1,074.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.89 / $4,916.00 / $12,850.00
| Facility | | $1,406.89 | $4,916.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.71 / $1,166.66 / $5,110.01
| Professional | | $640.71 | $1,166.66 | $5,110.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.82 / $1,226.28 / $1,661.28
| Professional | | $747.82 | $1,226.28 | $1,661.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.07 / $1,012.57 / $1,777.28
| Professional | | $645.07 | $1,012.57 | $1,777.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.86 / $1,363.56 / $6,679.00
| Facility | | $628.86 | $1,363.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.62 / $874.12 / $1,199.93
| Professional | | $721.62 | $874.12 | $1,199.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.11 / $1,548.47 / $2,042.68
| Professional | | $781.11 | $1,548.47 | $2,042.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $26,542.00
| Facility | | $2,324.00 | $5,097.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.61 / $1,205.99 / $5,110.01
| Professional | | $724.61 | $1,205.99 | $5,110.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,204.00 / $13,284.00
| Facility | | $2,324.00 | $6,204.00 | $13,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.15 / $1,001.16 / $1,945.43
| Professional | | $702.15 | $1,001.16 | $1,945.43 |