- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.73 / $3,107.00 / $5,851.00
| Facility | | $727.73 | $3,107.00 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.42 / $727.73 / $1,084.74
| Professional | | $651.42 | $727.73 | $1,084.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,628.72 / $26,542.00
| Facility | | $1,591.00 | $4,628.72 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.50 / $1,403.28 / $11,064.05
| Professional | | $761.50 | $1,403.28 | $11,064.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.68 / $3,212.69 / $3,212.69
| Professional | | $1,351.68 | $3,212.69 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.00 / $1,457.50 / $6,493.89
| Facility | | $1,325.00 | $1,457.50 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.16 / $1,142.29 / $2,205.09
| Professional | | $588.16 | $1,142.29 | $2,205.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.16 / $1,527.12 / $7,315.92
| Facility | | $704.16 | $1,527.12 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.02 / $1,030.81 / $1,547.28
| Professional | | $808.02 | $1,030.81 | $1,547.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.45 / $1,722.22 / $2,223.88
| Professional | | $872.45 | $1,722.22 | $2,223.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $6,204.00 / $26,542.00
| Facility | | $1,591.00 | $6,204.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.17 / $1,413.14 / $11,064.05
| Professional | | $820.17 | $1,413.14 | $11,064.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.29 / $1,110.07 / $2,949.07
| Professional | | $746.29 | $1,110.07 | $2,949.07 |