- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.26 / $2,747.00 / $5,454.00
| Facility | | $984.26 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.13 / $691.93 / $1,106.17
| Professional | | $577.13 | $691.93 | $1,106.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,809.76 / $7,608.00
| Facility | | $818.35 | $3,809.76 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.95 / $1,167.33 / $4,902.16
| Professional | | $690.95 | $1,167.33 | $4,902.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.88 / $1,323.91 / $1,793.44
| Professional | | $892.88 | $1,323.91 | $1,793.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.45 / $1,129.24 / $1,933.40
| Professional | | $712.45 | $1,129.24 | $1,933.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,104.03 / $8,090.00
| Facility | | $300.00 | $1,104.03 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.52 / $945.46 / $1,295.40
| Professional | | $780.52 | $945.46 | $1,295.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.64 / $1,671.27 / $2,188.54
| Professional | | $846.64 | $1,671.27 | $2,188.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,793.00 / $2,899.73 / $10,806.79
| Facility | | $2,793.00 | $2,899.73 | $10,806.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.94 / $15,876.30 / $15,876.30
| Professional | | $1,597.94 | $15,876.30 | $15,876.30 |
- 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
- $737.47 / $1,246.93 / $4,902.16
| Professional | | $737.47 | $1,246.93 | $4,902.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.00 / $5,572.00 / $11,272.00
| Facility | | $1,850.00 | $5,572.00 | $11,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.18 / $1,048.35 / $1,985.54
| Professional | | $674.18 | $1,048.35 | $1,985.54 |