- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.35 / $2,663.12 / $3,693.00
| Facility | | $731.35 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.67 / $731.35 / $2,274.98
| Professional | | $218.67 | $731.35 | $2,274.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.27 / $6,078.00 / $16,394.00
| Facility | | $768.27 | $6,078.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.68 / $1,548.48 / $5,456.47
| Professional | | $344.68 | $1,548.48 | $5,456.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.66 / $481.86 / $945.18
| Facility | | $370.66 | $481.86 | $945.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.38 / $1,365.28 / $2,450.54
| Professional | | $533.38 | $1,365.28 | $2,450.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.96 / $1,653.36 / $3,319.41
| Professional | | $567.96 | $1,653.36 | $3,319.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.45 / $675.86 / $6,679.00
| Facility | | $314.45 | $675.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,375.42 / $1,621.42 / $2,691.86
| Professional | | $1,375.42 | $1,621.42 | $2,691.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.49 / $1,355.78 / $3,376.71
| Professional | | $396.49 | $1,355.78 | $3,376.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,434.40 / $2,434.40 / $2,434.40
| Professional | | $2,434.40 | $2,434.40 | $2,434.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.58 / $6,883.00 / $16,394.00
| Facility | | $2,070.58 | $6,883.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,311.20 / $2,868.76 / $7,853.44
| Professional | | $1,311.20 | $2,868.76 | $7,853.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,155.80 / $1,816.98 / $3,504.57
| Professional | | $1,155.80 | $1,816.98 | $3,504.57 |