- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.52 / $2,747.00 / $5,011.00
| Facility | | $849.52 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.16 / $849.52 / $1,253.76
| Professional | | $738.16 | $849.52 | $1,253.76 |
- 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
- $880.56 / $1,617.34 / $7,007.28
| Professional | | $880.56 | $1,617.34 | $7,007.28 |
- 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
- $636.02 / $1,347.74 / $2,575.58
| Professional | | $636.02 | $1,347.74 | $2,575.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $1,755.06 / $6,679.00
| Facility | | $714.00 | $1,755.06 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.55 / $1,184.67 / $1,889.51
| Professional | | $933.55 | $1,184.67 | $1,889.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.44 / $1,990.66 / $2,570.51
| Professional | | $1,008.44 | $1,990.66 | $2,570.51 |
- 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
- $940.28 / $1,617.34 / $7,007.28
| Professional | | $940.28 | $1,617.34 | $7,007.28 |
- 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
- $878.85 / $1,281.57 / $3,121.73
| Professional | | $878.85 | $1,281.57 | $3,121.73 |