- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.26 / $2,703.00 / $5,003.00
| Facility | | $722.26 | $2,703.00 | $5,003.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.83 / $827.01 / $1,207.71
| Professional | | $650.83 | $827.01 | $1,207.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $26,542.00
| Facility | | $1,061.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.27 / $1,616.65 / $6,212.32
| Professional | | $761.27 | $1,616.65 | $6,212.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.11 / $1,015.29 / $1,810.93
| Facility | | $790.11 | $1,015.29 | $1,810.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $3,212.69 / $3,212.69
| Professional | | $855.84 | $3,212.69 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $920.70 / $6,493.89
| Facility | | $837.00 | $920.70 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.48 / $1,313.91 / $2,539.83
| Professional | | $687.48 | $1,313.91 | $2,539.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.54 / $1,440.68 / $6,679.00
| Facility | | $669.54 | $1,440.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.65 / $1,263.60 / $1,840.93
| Professional | | $987.65 | $1,263.60 | $1,840.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.69 / $1,808.81 / $2,347.10
| Professional | | $900.69 | $1,808.81 | $2,347.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,616.58 / $26,542.00
| Facility | | $1,061.00 | $4,616.58 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.49 / $2,014.14 / $6,212.32
| Professional | | $950.49 | $2,014.14 | $6,212.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.93 / $1,290.15 / $3,099.14
| Professional | | $858.93 | $1,290.15 | $3,099.14 |