- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.73 / $2,703.00 / $5,048.00
| Facility | | $970.73 | $2,703.00 | $5,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.24 / $681.79 / $1,753.29
| Professional | | $593.24 | $681.79 | $1,753.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,756.78 / $12,124.49
| Facility | | $818.35 | $3,756.78 | $12,124.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.84 / $1,136.33 / $5,719.42
| Professional | | $671.84 | $1,136.33 | $5,719.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.37 / $1,307.53 / $1,771.36
| Professional | | $797.37 | $1,307.53 | $1,771.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.84 / $1,095.00 / $1,908.82
| Professional | | $707.84 | $1,095.00 | $1,908.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.55 / $1,453.92 / $6,679.00
| Facility | | $671.55 | $1,453.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.60 / $933.45 / $1,279.45
| Professional | | $770.60 | $933.45 | $1,279.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.17 / $1,655.64 / $2,184.05
| Professional | | $835.17 | $1,655.64 | $2,184.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,788.20 / $2,788.20 / $18,953.84
| Facility | | $2,788.20 | $2,788.20 | $18,953.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.83 / $5,601.50 / $5,601.50
| Professional | | $1,052.83 | $5,601.50 | $5,601.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,287.00 / $11,272.00
| Facility | | $55.00 | $4,287.00 | $11,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.11 / $1,232.83 / $5,719.42
| Professional | | $728.11 | $1,232.83 | $5,719.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.94 / $1,047.91 / $2,102.12
| Professional | | $710.94 | $1,047.91 | $2,102.12 |