- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.58 / $2,822.00 / $6,075.00
| Facility | | $755.58 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.21 / $755.58 / $1,093.22
| Professional | | $677.21 | $755.58 | $1,093.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,799.27 / $26,542.00
| Facility | | $1,591.00 | $4,799.27 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.14 / $1,422.29 / $6,710.08
| Professional | | $719.14 | $1,422.29 | $6,710.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.48 / $1,470.14 / $3,212.69
| Professional | | $896.48 | $1,470.14 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,051.59 / $6,493.89
| Facility | | $956.00 | $1,051.59 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.67 / $1,222.71 / $2,359.31
| Professional | | $619.67 | $1,222.71 | $2,359.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.79 / $1,634.64 / $6,679.00
| Facility | | $748.79 | $1,634.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.24 / $1,103.38 / $1,668.26
| Professional | | $859.24 | $1,103.38 | $1,668.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.14 / $1,814.38 / $2,342.89
| Professional | | $919.14 | $1,814.38 | $2,342.89 |
- 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
- $794.18 / $1,422.29 / $6,710.08
| Professional | | $794.18 | $1,422.29 | $6,710.08 |
- 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
- $747.05 / $1,153.55 / $2,484.91
| Professional | | $747.05 | $1,153.55 | $2,484.91 |